ASCO: Two More FL Studies to Look At

The ASCO conference took place a few weeks ago, and I've already written about a bunch of the Follicular Lymphoma presentations from this year. But I also know that, in the weeks after the conference, lots of oncology websites give some analysis, with experts giving their opinion about how important some of the research is. I like these analyses, for two reasons. First, sometimes they talk about presentations that I already wrote about, and it makes me feel smart to know that I kind of guessed right about what's important. 

But I also like it when the articles bring up ASCO presentations that I didn't write about. I'm not an oncologist or a cancer researcher, as I like to remind you all. I like learning more about our disease, and I learn most from the people who are actually experts.

The article that caught my eye is from The ASCO Post, published by ASCO, and is called "Hematology Highlights From ASCO 2022." It looks at a few ASCO presentations that deal with blood cancer, including two that look at Follicular Lymphoma.

The first is a report on the ROSEWOOD trial, which looks at Zanubrutinib added to Obinutuzumab.

Zanubrutinib is a BTK Inhibitor. Like all inhibitors, its job is to inhibit, or stop a process from happening. In the case of BTK Inhibitors, it inhibits Bruton's Tyrosine Kinase, which helps B cells develop. Zanubrutinib is already approved for several other lymphomas.

Obinutuzumab, as you might remember, is a monoclonal antibody like Rituxan.

The ROSEWOOD trial compared Zanubrutinib and Obinutuzumab with Obinutuzumab by itself. The combination improved Overall Response Rate (85.4% versus 72.6%), Progression-Free Survival (27.4 months versus 11.2 months), but could not show a difference in Overall Survival (which is not surprising -- very few new treatments can do that). 

The trial involves FL patients with relapsed or refractory disease (the last treatment didn't work or stopped working). No details on side effects, but the lead researcher was quoted as saying the combination had a"favorable benefit-risk profile," and this could provide another option for R/R FL patients.

The second FL study discussed Epcoritamab added to R-Squared.

Epcoritamab is a bi-specific (I've been writing a lot about them lately). R-Squared is the combination of Rituxan and Revlimid (also known as Lenalidomide). 

The combination resulted in a 100% response rate in 28 R/R FL patients in the EPCORE NHL-2 trial, with all but one patient getting a Complete Response. 93% of the patients maintained their response at 6 weeks.

The side effect that the researchers seemed most concerned about was Cytokine Release Syndrome. There was a "low incidence" that was "predictable" and managed. Other side effects: "injection-site reactions in 53% of patients, cytokine-release syndrome in 50%, constipation in 47%, neutropenia [low white blood cells called netrophils] in 47%, fatigue in 40%, cough in 37%, and rash in 33%. Neutropenia was the most frequent grade 3 or 4 treatment-emergent adverse event."

The potential problem with a "triplet" or combination of three treatments is that there might be three times the side effects. That doesn't seem to be an issue in this combination, at least in this analysis.

More details of both studies are available in the ASCO Post article.

The post is a nice reminder that there are still plenty of trials being run for FL, with lots more potential treatments available for us. It's also a nice reminder that clinical trials can't be run without patients who volunteer for them, so keep talking to your oncologists about potential trials that might be appropriate for you. 

I'll keep an eye out for more ASCO analysis, and share what I learn.