New therapies for follicular lymphoma on the horizon

Recently approved targeted and immunotherapy drugs are helping patients diagnosed with follicular lymphoma live longer. Knowing the available treatment options can help physicians recommend the most appropriate treatment for their patients with newly diagnosed or relapsed or refractory follicular lymphoma.

For nearly 40 years, chemotherapy was the standard of care for follicular lymphoma, which is the second most common non-Hodgkin lymphoma and the most common slow-growing lymphoma. The standard of care has changed with the advent of targeted drugs that block the disease’s growth by interfering with molecules on the surface of cancer cells, and with immunotherapy drugs that enlist the body’s own immune system to fight the disease.

“We’ve seen a paradigm shift in the past five years, with most new treatment regimens incorporating novel targeted or immunotherapeutic agents,” said Nathan Fowler, M.D., associate professor of Lymphoma and Myeloma.

As a result of the shifting standard of care, outcomes have improved for patients with follicular lymphoma, Fowler said.

“Several long-term follow-up studies of patients who have received current standard therapies have shown that, unlike patients 10 to 15 years ago,” he stated, “most patients today will not die of their disease.”

The standard of care for follicular lymphoma continues to evolve. Several multicenter phase III randomized controlled trials comparing new treatment regimens with standard therapies are ongoing or recently completed, and Fowler expects some of these new regimens to be approved by the Food and Drug Administration within the next few years.

The combination of rituximab and the immune modulator lenalidomide, a regimen commonly known as R2, is in phase III trials for patients with previously untreated or relapsed/refractory follicular lymphoma. Fowler expects to see preliminary results in the coming months.

A phase III trial of obinutuzumab and chemotherapy in patients with previously untreated follicular lymphoma also recently completed enrollment. Fowler anticipates the combination’s approval as a first-line therapy.

Two ongoing phase III trials are evaluating the Bruton tyrosine kinase inhibitor ibrutinib, which is approved for the treatment of other slow-growing lymphomas, for patients with follicular lymphoma. Fowler is the national principal investigator for one of the trials, which will soon begin enrolling patients at MD Anderson.

Chemotherapy can create long-term toxic side effects, Fowler said.  

“Patients with follicular lymphoma are surviving longer today, so we’re looking to targeted and immunotherapy drugs because patients are going to have to live with this disease along with any side effects of the treatment.”

Read more about advances in follicular lymphoma treatment in Oncolog.