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Regimens Emerging Beyond Chemo in Follicular Lymphoma

Caroline Seymour
Published: Wednesday, Sep 05, 2018

Celeste Bello, MD

Celeste Bello, MD

Novel treatment regimens are showing potential in patients with follicular lymphoma, especially those without a chemotherapeutic backbone, explained Celeste Bello, MD, a hematologist/oncologist at Moffitt Cancer Center.

Results from the phase III RELEVANCE trial demonstrated similar efficacy between the combination of rituximab (Rituxan) and lenalidomide (Revlimid; R2) and rituximab and chemotherapy in patients with untreated follicular lymphoma.1 Data presented at the 2018 ASCO Annual Meeting showed that at a follow-up of 120 weeks, R2 induced a complete remission (CR) rate of 48% versus 53% with rituximab/chemotherapy (P = .13).

The objective response rates were 84% and 89% with the R2 and rituximab/chemotherapy regimens, respectively. The 3-year duration of response rates were 77% and 74%, respectively, making the R2 regimen a viable and more tolerable nonchemotherapeutic frontline approach for patients.

In addition to the RELEVANCE trial, data were presented for duvelisib, a novel inhibitor of the PI3Kδ and PI3Kγ pathways. In April 2018, the FDA granted a priority review to the drug for the treatment of patients with relapsed/refractory follicular lymphoma.

In an interview during the 2018 OncLive® State of the Science SummitTM on Hematologic Malignancies, Bello discussed the latest advances in the treatment of patients with follicular lymphoma.

OncLive: What were some of the updates you covered in your presentation on follicular lymphoma?

Bello: I gave updates on some of the newer treatment options that are available. Two of the drugs were presented at the 2018 ASCO Annual Meeting. One was duvelisib, which is a newer PI3K inhibitor. We also saw the preliminary results of the RELEVANCE trial, which looked at the combination of lenalidomide and rituximab in the upfront setting.

Can you explain the design and findings of the RELEVANCE trial?

It enrolled over 1000 patients who were previously untreated with low-grade follicular lymphoma and randomized them to lenalidomide and rituximab or investigator’s choice of chemotherapy––either CHOP and rituximab (R-CHOP), bendamustine and rituximab (BR), or CVP and rituximab. After [approximately] 6 months of treatment, if patients obtained either a CR or a partial remission, they were put on a maintenance treatment for 1 or 1.5 years depending on what line of treatment they were on.

At the 2018 ASCO Annual Meeting, preliminary data were presented and showed that there was no difference between lenalidomide/rituximab and chemotherapy. The take-home message was that it’s a nonchemotherapy regimen that had just as good a response as a chemotherapy regimen. We always have to be cautious, because if you jump onboard too early [you may] find out that there are some problems later on. It will be really interesting to see the long-term data, which will probably be [presented] at either the 2019 ASCO Annual Meeting or the 2019 ASH Annual Meeting.

What do physicians think about the results? Were they hoping to see superiority with R2?

I don’t think most people know about the data just yet because it's fairly new, so I don't think there are feelings either way just yet. The people who were aware of the study are very excited about it because it's a nonchemotherapy option. Patients with follicular lymphoma live a long time; it's managed like a chronic illness. It’s a great option if you can give them a nonchemotherapy option with very little adverse events and no hair loss, nausea, or vomiting.

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