New Treatment Strategies for Follicular Lymphoma - Episode 9
Carla Casulo, MD: Immunomodulation in follicular lymphoma has a very strong future, and it’s a very rational choice because of the effect of the tumor microenvironment in follicular lymphoma. The MD Anderson Cancer Center first demonstrated that patients with follicular lymphoma treated with lenalidomide and rituximab did very well. Their overall response rate was almost 100%, which is very, very promising. The CALGB [Cancer and Leukemia Group B] also looked at the combination of lenalidomide and rituximab. They, too, showed that the combination was very promising, with a progression-free survival that was very high, about 89%, at 2 years.
The ongoing RELEVANCE study is looking at lenalidomide and rituximab as well in a randomized study compared with other chemotherapeutic regimens for the frontline setting. So, I think that this is looking at possibly impacting a new frontline chemotherapy-free or nonchemotherapy-containing approach for patients who have newly diagnosed disease and are in need of therapy.
The key findings from the ALLIANCE trial, which looked at lenalidomide and rituximab in previously untreated follicular lymphoma, is that the 2-year progression-free survival was 86% in those patients. The overall response rate was 95%. Importantly, at 5 years, the overall survival was 100%. So, I think this demonstrates that the frontline use of lenalidomide/rituximab is very promising.
Nathan H. Fowler, MD: R2, or lenalidomide and rituximab, has been looked at in many different settings in many different indications. As I mentioned earlier, it has been looked at in the front line in follicular lymphoma. It’s been looked at in relapsed disease with follicular lymphoma, and at this meeting, we also saw lenalidomide and rituximab used as maintenance therapy following bendamustine and rituximab induction. This is part of the BIONIC trial, a cooperative group trial that looked at basically 3 arms of patients with follicular lymphoma. There was an arm with bendamustine/rituximab followed by lenalidomide/rituximab maintenance, bendamustine with rituximab maintenance, and bendamustine, Velcade [bortezomib], and rituximab with rituximab maintenance.
This study showed very similar findings between all 3 arms. What that means is that bendamustine/rituximab with rituximab looked about the same as bendamustine/rituximab with lenalidomide/rituximab maintenance. And unfortunately, there was increased toxicity with lenalidomide/rituximab following bendamustine/rituximab. So, that’s a very complex way to say that I think, at least in this trial, there did not appear to be a benefit of lenalidomide/rituximab following bendamustine compared with just rituximab alone.
Transcript Edited for Clarity