Balancing Risk and Efficacy in Follicular Lymphoma Treatment

Christopher R. Flowers, MD, MS, Department of Lymphoma - Myeloma, Division of Cancer Medicine at MD Anderson Cancer Center, discusses what the current treatment landscape of follicular lymphoma looks like.

According to Flowers, follicular lymphoma often affects older adults and is generally incurable with standard therapies. The current management of this disease ranges from "watch and wait" strategies for asymptomatic cases to aggressive first-line treatments like multiagent chemotherapy with antibody therapy.

Some cases, including for patients who relapse, may require advanced options such as chimeric antigen receptor (CAR)T-cell therapy or autologous stem cell transplantation. Treatment complexity has grown due to the withdrawal of certain relapsed-setting drugs, like PI3 kinase inhibitors, which were removed due to long-term toxicity concerns outweighing initial benefits. This shifting therapeutic landscape highlights the need for evolving management strategies to balance efficacy and safety in treating follicular lymphoma.

Transcription:

0:09 | Follicular lymphoma as a disease can be quite complicated. In terms of its management strategies, I think it is a disease that is considered not to be curable with standard therapy, and a disease that typically affects older individuals, patients in their 70s and older being the average time when people are first diagnosed.

0:36 | There are a variety of treatments that can be used in the first-line. Those can vary from things like just watching and waiting after someone is diagnosed until they develop signs or symptoms that require treatment, to treatments that are much more aggressive, like multiagent chemotherapy combined with antibody therapy as first-line therapies and things that are aggressive like CAR T-cell therapy and autologous stem cell transplantation when patients have relapses of their diseases. There are multiple other options that are included in between.

1:17 | The other thing that has become challenging about the management for patients with follicular lymphoma is that there have been various classes of agents that were available for patients in the relapsing setting, like the PI3 kinase inhibitors, where we found toxicity over time with those drugs being on the marketplace, or that the benefits that were originally viewed for those agents no longer outweigh the risks of those agents. Those treatments have been withdrawn from the market more recently.