Last month, the 25th Annual International Congress on Hematologic Malignancies: Focus on Leukemias, Lymphomas, and Myeloma took place. This event has obviously been around for quite a while, and it's an opportunity for oncologists to get the latest information about blood cancers from specialists in the area.
So in that way, it's not necessarily a place to get cutting edge research. It's more about hearing from experts about what's new in the field, and thinking about how that research might work in a clinical setting -- with real patients sitting in an exam room, trying to make decisions.
The session on Indolent Lymphomas (including Follicualr Lymphoma) was led by Dr. Lori Leslie, co-Medical Director of the Cancer Program at Mountainside Medical Center, and Director of the Indolent Lymphoma and CLL Research Programs at John Theurer Cancer Center, both in New Jersey. (She seems very cool -- she has a few videos from last December on the OBR Oncology YouTube channel.)
So, again, the presentation wasn't necessarily about new stuff that people were hearing about for the first time, but more a summing up of where we are, based on recent research. If you've been reading for a while, I like these kinds of posts. It's good to be reminded of where we are.
The Congress was not available online (and I couldn't have afforded to go to it anyway), but OncLive provides a nice summary of Dr. Leslie's session.
The main point, at least as presented in the article, is that Immunochemotherapy remains the most popular first treatment for Indolent Lymphomas like FL. This includes Rituxan + Bendamustine (B-R), R-CHOP, and R-CVP.
More recently, Obinutuzumab has sometimes been used a replacement for Rituxan in those combos. Obinutuzumab and Rituxan are similar in many ways, including the Overall Survival that comes from using them. However, Obinutuzumab also has a little higher median Progression-Free Survival -- that is, it takes longer for the disease to come back after treatment. On the other hand, Rituxan has a little better safety, with fewer patients in trials getting serious side effects. Both need to be taken into consideration when choosing which treatment to go with.
Another first line treatment to consider is R-Squared (Rituxan plus Revlimid/Lenalidomide). In a study that compared R-Squared to Immunochemotherapy, the two treatments were about equally effective, with different side effects. It could be an option for patients who wouldn't do as well with chemotherapy (because, for example, it might be too hard on their bodies).
The question of Maintenance was also addressed. Some patients receive Rituxan or Obinutuzumab Maintenance -- after they receive their first treatment, they receive a monoclonal antibody every couple of months for two years. For some patients, it seems to help improve their PFS and Overall Survival, but for others, the side effects of having a less effective immune system for two years might not be worth it. It's been a controversial strategy for a long time, and it remains so, with no easy answers.
Dr. Leslie also discussed targeted therapies -- non-chemo treatments that do a better job than chemo of finding cancer cells and leaving healthy cells alone. These include single-agent Obinutuzumab, inhibitors like Ibrutinib (which works well for other indolent blood cancers, but not so well for Follicular Lymphoma, and no one knows why for sure), and some other inhibitors. They tend to better right now when they are used as part of combinations. Still lots of hope with them, though.
No mention of CAR-T in this presentation. My guess is that it got its own session at the Congress.
So some interesting stuff here. As I said, I think it's valuable to know where we are, and to review recent research. It helps me figure out what we still need to know -- and what I should be paying attention to.
And, of course, it reminds me of the options I already have available. That's always a good thing.
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