Frontline Therapy In Follicular Lymphoma - Episode 18

Challenges in the Treatment of Follicular Lymphoma


Laurie H. Sehn, MD, MPH: The primary challenge with treating patients with follicular lymphoma is the unknown. Although patients could have very good outcomes to very heterogenous disorder, what we don’t know is who’s going to do well and who’s not going to do well. So it’s hard to tailor therapy right from the beginning.

What we want to do is come in with our best-available treatment that’s well tolerated and hopefully get that patient into a very durable remission, because we know that you know when patients experience relapsed and refractory disease, it can be harder to get them back under control. I’m optimistic that you know a lot of the novel therapies under development will ultimately make their way up front and hopefully improve treatment for patients overall in the frontline setting.

Recently we saw data from the RELEVANCE trial, where chemotherapy-free option of lenalidomide and rituximab actually was very effective in the frontline setting. We’re currently exploring other targeted agents in relapsed-refractory setting that will inevitably move up and be tested in the frontline. Improving on monoclonal antibodies using obinutuzumab, using other directed agents such as polatuzumab, which is the novel antibody-drug conjugate as well with efficacy in follicular lymphoma.

Currently there are a variety of immunotherapies being tested including bispecific antibodies, which are showing a lot of promise in follicular lymphoma, and ultimately we’d like to see those tested up front as well. Certainly, given the fact that follicular lymphoma is an indolent disease and we know that the immune system plays an instrumental role in its behavior and its treatment, I think immunotherapies show a lot of potential promise as an important modality for treating follicular lymphoma in the future.

Information is changing very rapidly in terms of how best we might manage patients with follicular lymphoma. It’s important to keep up with the literature and ensure that patients are getting the most appropriate therapy. But patients with follicular lymphoma generally do very well, and the therapies we have right now have been improving. Our current therapies of combination chemotherapy and monoclonal antibodies, and hopefully movement toward even chemotherapy-free options really has led to an improvement in outcomes in patients overall. We expect that further developments and novel therapies will continue to add to the progress that we’ve seen.

Transcript Edited for Clarity