Follicular Lymphoma Case Study

Targeted Oncology has a short video series (8 videos, each no more than 5 minutes) featuring an oncologist discussing a particular patient with Follicular Lymphoma and how she has treated him (and would treat him in other situations).

I like video series like this. It gives me a sense of how an oncologist would treat FL in the "real world." Sometimes I read so much about possible treatments and early clinical trials that I forget about what is actually available right now. So it's nice to hear an expert talk about how she handles things.

That expert is Dr. Kami Maddocks from Ohio State University. The patient she is discussing is a 74 year old man who had complained of fatigue and weight loss for 6 months. A scan showed some swollen nodes and a biopsy showed stage 4/grade 2 Follicular Lymphoma. The first video in the series talks about his case and his initial treatment -- R-CHOP followed by Rituxan maintenance. He had a Complete Response, but then a recurrence 24 months later. He was given Rituxan and Bendamustine for his second treatment, with more maintenance. 

Then 12 months later, he complained of more symptoms. He was re-staged and found to have grade 2 FL, and was given Idelalisib, an inhibitor. 

From there, the videos talk in more general terms, with this patient being used as an example -- how oncologists can use things like FLIPI to help guide them. 

The second video talks more about first-line treatment options, straight Rituxan to Immunochemotherapy (like R-CHOP or R-B, or Obinutuzumab in place of R). [No mention of R-squared as a first-line option, which is interesting.]

The third video looks at Maintenance, and when it is (or isn't) a good idea.

The fourth video looks at how Dr. Maddocks monitors patients to make sure the FL hasn't come back -- how often to meet with the patient, when to do blood work, and how often to order a CT scan. 

Finally, the fifth video discusses options for second-line treatment, generally an Immunochemotherapy, and why she usually likes to hold off on using R-CHOP (because it's useful if a patient transforms, but can only be used once, because it can cause heart damage).

The sixth, seventh, and eighth videos get into how she handles treatment if the second-line treatment failed (usually with an inhibitor), and what factors she considers (such as the health of the patient), and then some discussion of where research is headed for FL (including CAR-T and bispecifics).

And hey -- here's a nice quote: "Lastly, as I mentioned that the median OS of FL is over 20 years, so when we’re considering different therapies, it’s also important to think about the toxicities of these therapies in the quality of life for a patient."

I'll repeat the good part: "The median Overall Survival of Follicular Lymphoma is over 20 years." 

I think this is a pretty good summary for anyone at any stage of the disease experience, to give a sense of what the next steps might look like. For me, I feel less stressed if I know what my possible path might be. That possible path changes all the time, with new research and new treatments. That's another reason I like videos like these -- they help me keep up with what's going on.

Also -- each video has a transcript below it, in case translation is a concern.

I hope you enjoy this series. I did.