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Cause for Optimism in Follicular Lymphoma Treatment

Panelists: Ian W. Flinn, MD, PhD, Sarah Cannon Research Institute; Peter Martin, MD, MS, Weill Cornell Medicine; Loretta J. Nastoupil, MD, University of Texas MD Anderson Cancer Center; Grzegorz S. Nowakowski, MD, Mayo Clinic; Anas Younes, MD, Memorial Sloan Kettering Cancer Center
Published: Thursday, Feb 21, 2019



Transcript: 

Ian W. Flinn, MD, PhD: This has been extremely informative. Before we end this discussion, I’d like to get final thoughts from each of our panelists. Dr Fowler?

Nathan H. Fowler, MD: The good news is that patients have more and more options. Sometimes I guess that makes our job a little more difficult. At least today, unfortunately, most of the novel drugs that are available are not changing the natural history of the disease for the patients for whom it matters most. So I think in the future, the way we’re going to really impact the most at-risk patients is to figure out how to use these drugs in combination or develop drugs that have better CR [complete response] rates, better progression-free survival. So, again, a lot of exciting drugs that are working at least independently so far, but the next generation is to figure out how do we boost that CR rate or how do we use these drugs in combination without the toxicity that we’ve seen with some of the early trials.

Ian W. Flinn, MD, PhD: Almost the parallels in chronic lymphocytic leukemia: getting people multiple agents, getting people into molecularly defined complete remissions, and hope that that translates into an improvement in overall survival and maybe, let’s talk about it, cure hopefully.

Nathan H. Fowler, MD: Yes.

Ian W. Flinn, MD, PhD: Ajay, what do you think?

Ajay K. Gopal, MD, FACP: I would concur. It’s becoming increasingly complex, but I’m really very excited about the options that we have. It’s nice for me to sit down with someone who has newly diagnosed follicular lymphoma and be able to confidently say that by far, your survival should match age-matched controls. And really until recently, we didn’t have the data to know that, and we even have an imperfect way to try to figure out who’s in that category. Ideally, we’d know at the very beginning, but we usually know after the first remission. But it makes it increasingly complex about how we strategize. And I don’t think any of us really know the answer how to strategize, but we think about the long game, particularly in our young patients. And all these options keep giving us additional cards to play as we try to get patients to a normal quality of life and normal longevity.

Ian W. Flinn, MD, PhD: Scott, final thoughts?

Scott Huntington, MD, MPH, MSc: Complexity is the key point. Every meeting impressed in me that the fields are advancing, not only in lymphoma, hematology broadly, and medical oncology. And so I think as a group we need to also work on translating from these clinical trials to the real world. It’s an incredibly complex healthcare delivery system, and basically delivering modern cancer care these days, and so I think we also need to be mindful of developing these algorithms to basically guide therapy that is individualized. It’s easier for us to individualize therapy because we have lots of patient panels. But out there in the community, where the majority of follicular lymphoma patients are receiving care, the individualization may be more challenging, and so I think we need to be mindful of that as well.

Ian W. Flinn, MD, PhD: I think those are really important points that everyone’s had here. Thank you all for your contributions to this discussion. On behalf of our panel, we thank you for joining us, and we hope you found this OncLive® Peer Exchange discussion to be useful and informative.


Transcript Edited for Clarity
 

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Transcript: 

Ian W. Flinn, MD, PhD: This has been extremely informative. Before we end this discussion, I’d like to get final thoughts from each of our panelists. Dr Fowler?

Nathan H. Fowler, MD: The good news is that patients have more and more options. Sometimes I guess that makes our job a little more difficult. At least today, unfortunately, most of the novel drugs that are available are not changing the natural history of the disease for the patients for whom it matters most. So I think in the future, the way we’re going to really impact the most at-risk patients is to figure out how to use these drugs in combination or develop drugs that have better CR [complete response] rates, better progression-free survival. So, again, a lot of exciting drugs that are working at least independently so far, but the next generation is to figure out how do we boost that CR rate or how do we use these drugs in combination without the toxicity that we’ve seen with some of the early trials.

Ian W. Flinn, MD, PhD: Almost the parallels in chronic lymphocytic leukemia: getting people multiple agents, getting people into molecularly defined complete remissions, and hope that that translates into an improvement in overall survival and maybe, let’s talk about it, cure hopefully.

Nathan H. Fowler, MD: Yes.

Ian W. Flinn, MD, PhD: Ajay, what do you think?

Ajay K. Gopal, MD, FACP: I would concur. It’s becoming increasingly complex, but I’m really very excited about the options that we have. It’s nice for me to sit down with someone who has newly diagnosed follicular lymphoma and be able to confidently say that by far, your survival should match age-matched controls. And really until recently, we didn’t have the data to know that, and we even have an imperfect way to try to figure out who’s in that category. Ideally, we’d know at the very beginning, but we usually know after the first remission. But it makes it increasingly complex about how we strategize. And I don’t think any of us really know the answer how to strategize, but we think about the long game, particularly in our young patients. And all these options keep giving us additional cards to play as we try to get patients to a normal quality of life and normal longevity.

Ian W. Flinn, MD, PhD: Scott, final thoughts?

Scott Huntington, MD, MPH, MSc: Complexity is the key point. Every meeting impressed in me that the fields are advancing, not only in lymphoma, hematology broadly, and medical oncology. And so I think as a group we need to also work on translating from these clinical trials to the real world. It’s an incredibly complex healthcare delivery system, and basically delivering modern cancer care these days, and so I think we also need to be mindful of developing these algorithms to basically guide therapy that is individualized. It’s easier for us to individualize therapy because we have lots of patient panels. But out there in the community, where the majority of follicular lymphoma patients are receiving care, the individualization may be more challenging, and so I think we need to be mindful of that as well.

Ian W. Flinn, MD, PhD: I think those are really important points that everyone’s had here. Thank you all for your contributions to this discussion. On behalf of our panel, we thank you for joining us, and we hope you found this OncLive® Peer Exchange discussion to be useful and informative.


Transcript Edited for Clarity
 
View Conference Coverage
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Oncology Briefings™: Individualizing Treatment After Second-Line Therapy for Patients With mCRCAug 29, 20191.0
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