Year-End Predictions

This is the last time I'll be posting in 2024. It's been an interesting year, for me personally and for the world of Follicular Lymphoma.

I had considered using this last post of the year to come up with a top 10 (or more likely a top 5) list of things that happened in 2024 related to FL. But honestly, I'm too busy and too tired, and even when I get a small break, something seems to fill my time. (Yesterday, it was our dog, who had to go to the hospital with an infection. She's doing fine. But my wife and I spent way more time than we wanted to trying to figure out how to get her to swallow her antibiotic pill. Our final solution involved American cheese, coconut milk-based yogurt, and cheese popcorn. But we got the job done.)

So instead of my going back and re-reading all of those posts and journal articles and figuring out how to rank them, I'm going to do something slightly different. I'm going to make three predictions about the long-term prospects of some of the FL-related things that happened this year. Maybe I'll remember to check in next year and see if I was right (though I think these might take more than a year to really work themselves out.

Prediction #1: Tafasitamab won't be the "game-changer" that the headlines predict it will. I've mentioned this a few times in the last month or so. The Big News fro the ASH meeting was the results of the stage 3 trial for Tafasitamab + Rituxan + Revlimd. Even before the ASH meeting, there were articles about how great the results were. And they were great. This is a non-chemo treatment with manageable side effects. It's been called a "game-changer." But to me, it's not going to change a lot of the ways that oncologists treat FL. As excited as many Lymphoma experts are about this, it matches the excitement that they had about R-Squared (Rituxan + Revlimid) a few years ago. But that doesn't mean that oncologists are recommending it. A survey by the Follicular Lymphoma Foundation found that only 6.2% of FL patients had received Revlimid (Lenalidomide), with or without Rituxan. I can't imagine that number is going to get bigger when a third agent is added to the mix. To be clear -- this combination is probably going to be approved by the end of 2025, and it's going to help a lot of people. But I predict that it won't be a game-changer. It won't become the default treatment for FL any time soon. Oncologists are creatures of habit. If you're seeing a generalist oncologist, get a second opinion from a Follicular Lymphoma expert if you can. See what other options are out there.

Prediction #2: Epcoritamab will have cause some concerns.  The ASH presentations for Epcoritamab, which was approved by the FDA this year, were very positive. It's the second bispecific approved by the FDA for FL. But the presentations also mentioned some safety issues. The same safety issues were voiced just after Epcoritamab data was presented at ASCO this year. The issues can be explained -- the clinical trial ran during the Covid pandemic, and like most FL treatments, Epcoritamab causes some immune system issues, which were especially important during Covid. Clearly, those issues were not enough to keep the FDA (or the EU) from approving it. But I have a feeling that there will be enough lingering concerns from oncologists that Epcoritamab won't be as widely used as it could be. I certainly hope that this isn't true, but my gut tells me those concerns haven't been completely answered. 

Prediction #3: There Won't Be Any Major Changes to the FDA Approval Process. This one is tricky. Back in March, I wrote about a movement to make the FDA cut back on surrogate endpoints and focus on Overall Survival. This would mean a longer, more rigorous approval process. However, in the second part of the year, political changes in the U.S. could potentially make it more likely that the FDA will loosen up regulations and be more friendly toward pharmaceutical companies, which  might make the process easier. Or maybe the opposite -- an FDA that does not have close relationships to people in the pharma industry. Honestly, I can't predict that, and we won't know what exactly will happen for another month at the earliest. But there is lots of speculation about potential good and bad changes at the agency and potential harm or help for cancer patients. My prediction? There will ultimately be little change. There might be a lot of big talk about change, but there will be very little actual change. Cancer treatments will remain safe and effective and will get approved only when they're ready. All of th talk won't match the reality.

So there you have it. My three FL predictions for 2025.

I want to remind you all that I am not an oncologist, or a cancer biologist, or a pharma insider, or anyone else that has any kind of information that would help with these predictions. Just a cancer patient who reads a lot. 

I hope you all have a Happy New Year. Eat your grapes, your black eyed peas, your soba noodles, your black bun, your crepes, and whatever else you eat to bring you good luck for the year. 

I'll be back soon with more. And you can all look forward to my diagnosiversary post in a coupe of weeks. I'll have some things to say.