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Expert Emphasizes Need to Enhance Treatment Strategies for Indolent Lymphomas

Gina Columbus @ginacolumbusonc
Published: Monday, Nov 21, 2016

Allison C. Rosenthal, DO

Allison C. Rosenthal, DO

Investigators are exploring therapy options for patients with indolent lymphomas—including follicular lymphoma, marginal zone lymphoma (MZL), and small lymphocytic lymphoma (SLL)—as rituximab (Rituxan) regimens are proving to not be a long-term option for many patients, explains Allison C. Rosenthal, DO.

In follicular lymphoma, for instance, an ongoing phase II trial is testing the first-line combination of rituximab plus ibrutinib (Imbruvica) in patients with advanced disease (NCT02451111). The primary endpoint of the randomized study is complete response.

A supplemental new drug application (sNDA) for ibrutinib as a treatment for patients with MZL was submitted to the FDA in September 2016. The application was based on the open-label phase II PCYC-1121 trial, which investigated the BTK inhibitor in patients with MZL following at least 1 prior therapy (NCT01980628).

In an interview during the 2016 OncLive State of the Science Summit on Treatment of Hematologic Malignancies, Rosenthal, a hematology consultant at Mayo Clinic, shared her insight on the need for updated treatment options for patients with indolent lymphomas, ongoing progress in the field, and the challenges oncologists are still facing in this space.

OncLive: Can you provide an overview of your lecture on indolent lymphomas?

Rosenthal: My presentation covered what exists now as an indolent lymphoma, including things such as follicular lymphoma, SLL, and MZL. The key points include, what do we currently have as treatment options for patients with follicular lymphoma? What kind of clinical trials are currently in progress to try and find targeted options for patients, or new ways of combining treatments that we already have? It took a look at what trials are in progress, what should we be looking for at national meetings this year, as far as updates go, and what might be the next wave of treatments available for these patients.

Other indolent lymphomas include Waldenström’s macroglobulinemia, some cutaneous lymphomas, and some non-Hodgkin lymphomas, as well.

What are the current treatment strategies?

Currently, our first-line treatment for most people who need therapy for indolent lymphomas includes rituximab alone, or rituximab in combination with chemotherapy. However, those strategies aren’t great for everyone. Some people have comorbidities or have reasons as to why they would want other strategies.

Also, not everyone responds to chemotherapy. It’s a great short-term option, but not a great long-term option that can be repeated for a lot of patients. Some of the targeted therapies that are new are oral and it is hopeful that they will be long-term options for patients that are tolerable and keep their disease under control for longer periods of time. So far, they are pretty new and we don’t have the experience yet to understand what they are going to offer patients in the long-term.

What are some of these newer targeted therapies?

Idelalisib (Zydelig) has already been approved for the treatment of patients with relapsed/refractory follicular lymphoma. Some patients do have good responses, but the toxicities can be pretty significant—hepatic toxicities, colitis, diarrhea, pneumonitis, and even some infections in patients who are severely immunocompromised. Therefore, where exactly that fits is a little bit unclear, and what safe combinations are out there are what we are exploring now.

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