The ASCO Post, a kind of newspaper for oncologists, published a video series on treating relapsed/refractory Follicular Lymphoma. If you've been reading for a while, you know how much I enjoy watching video series like this one. I like listening to experts get excited about treatment options.
For this series, the participants are Dr. Andrew M. Evens (Rutgers University), Dr. L. Elizabeth Budde (City of Hope Medical Center), and Dr. Carla Casulo (University of Rochester). What's especially interesting about this series is that instead of talking about treatments in general, they look at case studies of specific patients. That matters -- with a disease that can look really different for different people, it's interesting to see the kinds of factors that the oncologists consider when making treatment decisions. Of course, seeing the actual patient would be even better -- knowing their goals, their families, their histories, all of the things that make them people and not just "case studies." But even the few specific clinical details that are given are better in some ways than looking at statistics from a group of 100 patients in a clinical trial.
(By the way, each of the videos includes a transcript, in case you'd rather read or need to translate.)
The first video focuses on a patient who was diagnosed with grade 1/2 Follicular Lymphoma, and had successful treatment with Bendamustine and Rituxan. But the FL returned just 8 months later, making the patient POD24 (Progression of Disease within 24 months after receiving immuno-chemotherapy). About 20% of FL patients are POD24, and POD24 patients have a statistically lower survival rate than most FL patients. Reseachers have been payin special attention to this group, trying to identify biomarkers that could signal POD24 early on (right now, there's no clear way to predict it -- you just have to wait for it to happen). The discussion in the video talks about what POD24 is, the types of treatments available, and whether Auto Stem cell Transplants (using the patient's own stem cells, not a donor's) is still happening these days (you don't hear much about SCT anymore).
The second video discusses a patient who had successful treatment with Rituxan, followed by Rituxan maintenance. This worked for about 4 years, but then he had some leg swelling that showed a return of the FL. More importantly, he had multiple comorbidities -- other serious health issues -- that needed to be taken into account when deciding on a second-line treatment. The conversation for this video focuses on the importance of biopsies and molecular testing to determine a stage and grade for FL that has returned, and how those comorbidities influence the treatment recommendation. (I'll let you guess which treatment they recommended, then watch the video and see if you are right. I was sort of right.)
Finally, the third video looks at a patient looks at a patient who was treated with R-CHOP (a chemotherapy), and then with B-R when he relapsed (a second chemotherapy), and then presented again with grade 3 FL. This is yet another different situation, as the patient is in a high risk category and has exhausted his chemo options. If you guessed that this third-line treatment decision comes down to choosing between CAR-T and bispecifics, then give yourself a gold star for paying attention to what's going on in the world of FL.
As I said, it's an interesting series, and the focus on actual individuals really emphasizes how different this disease can be. It highlights how important it is to have conversations with your oncologist. I'll speak for myself -- I consider myself lucky to not need treatment right now, and that has given me time to stay up on what my options are. Maybe more importantly, it's given me time to let my oncologist get to know me. When the time does come for additional treatment, it won't be a case of just looking at numbers. He'll have a sense (I hope) of what matters to me, what my treatment goals are, and who I am. I think that's important.
I hope you enjoy the series.
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