Narendranath Epperla, MD
Clinical trials exploring novel combination regimens continue to advanced the treatment landscape for patients with follicular lymphoma and mantle cell lymphoma (MCL).
For example, the phase III GALLIUM trial combined obinutuzumab (Gazyva) with chemotherapy in the first-line setting and reduced the risk of disease progression or death by 34% versus rituximab (Rituxan) in patients with follicular lymphoma.
“Obinutuzumab continues to remain a very strong treatment modality in treatment of [patients with] follicular lymphoma, either in the relapsed/refractory setting or in the upfront setting,” said Narendranath Epperla, MD.
In the obinutuzumab arm of the GALLIUM study, the overall response rate was 88.5% versus 86.9% in the rituximab cohort. The 3-year progression-free survival (PFS) rate was 80% in the obinutuzumab arm versus 73.3% in the rituximab arm.
In an interview during the 2017 OncLive®
State of the Science SummitTM
on Hematologic Malignancies, Epperla, assistant professor of internal medicine, Department of Medicine, Division of Hematology, The Ohio State University, discussed the evolving treatment landscape for patients with follicular lymphoma and MCL.
OncLive®: Can you please provide an overview of your lecture?
: The GALLIUM study looked at using obinutuzumab plus chemotherapy versus rituximab and chemotherapy. Obinutuzumab and chemotherapy had improved response rates and PFS. However, one needs to note that it was obinutuzumab plus chemotherapy followed by obinutuzumab maintenance, or rituximab plus chemotherapy followed by rituximab maintenance. One should be aware of the side effect profile when giving obinutuzumab and chemotherapy as an infusion, but it is an exciting time in the field.
Finally, even in the relapsed/refractory setting, especially in the rituximab-refractory setting, we have seen impressive data with obinutuzumab/bendamustine followed by obinutuzumab maintenance compared with bendamustine monotherapy. In my clinical practice, for patients in the rituximab-refractory setting, I use obinutuzumab with bendamustine and obinutuzumab maintenance.
Are there any ongoing studies in the follicular lymphoma field that you are excited to see the results of?
We will see the primary results of the phase III RELEVANCE study, which compares rituximab plus lenalidomide (Revlimid) to rituximab plus chemotherapy in the upfront setting.
I am also interested or curious to see what the follow-up data on the GALLIUM study would be. I am looking forward to novel agents using BTK combinations and PI3-kinase combinations in the relapsed, indolent non-Hodgkin lymphoma setting, as well as in MCL.
Do you think immunotherapy will continue to have a role in this landscape?
There are some ongoing trials with checkpoint inhibitors in follicular lymphoma, which are being tested in the relapsed/refractory setting. However, we must await those results as none of the data are out yet. There might be a role for checkpoint inhibitors, but the more interesting question is, “How are we going to sequence when we have so many agents?” When we have the data, we will have to consider the baseline characteristics of each study to figure out how to best sequence them.
Switching gears to MCL, what role might modern immunotherapy have in this landscape?
There are many changes in the treatment armamentarium for MCL, which have been happening over the past few years. Most of the data that we have today are in the relapsed/refractory setting. I'm excited about some combinations, such as rituximab plus lenalidomide, as well as PI3K combinations in the relapsed/refractory setting.