New Treatment Options Benefit Patients With Relapsed/Refractory Follicular Lymphoma

Patients with relapsed/refractory follicular lymphoma tend to have a poorer response and shortened progression-free survival with each subsequent treatment, but new treatment options are emerging.

“Recently, three novel therapies that engage T cells have been approved by the Food and Drug Association (FDA) and have been incorporated into the treatment armamentarium of patients with follicular lymphoma with relapsed/refractory disease,” explained a review article recently published online in Frontiers in Oncology. “They include CD20/CD3-bispecific antibody mosunetuzumab and the CD19-directed chimeric antigen receptor (CAR) T-cell therapies axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel).”

In the article, authors Ryan Jacobs, MD, of Levine Cancer Institute in Charlotte, North Carolina, and Caron Jacobson, MD, of Dana–Farber Cancer Institute, Boston, Massachusetts, provide an overview of axi-cel, tisa-cel, and another CD-19 CAR T-cell therapy—lisocabtagene maraleucel (liso-cel). Liso-cel is approved for second-line or later treatment of patients with diffuse large B cell lymphoma and is under investigation for patients with relapsed/refractory follicular lymphoma.

The paper compares the CAR T-cell therapy agents with the CD20/CD3-bispecific monoclonal antibody mosunetuzumab.

“It is likely that both bispecific antibodies and CAR T-cell therapies will have significant roles in the future management of relapsed/refractory follicular lymphoma, but their sequencing remains to be defined,” the authors wrote.

Benefits of mosunetuzumab, which showed durable responses in a recent follow-up of patients with relapsed/refractory follicular lymphoma, include its off-the-shelf availability. On the other hand, CAR T-cell therapy offers the longest progression-free survival in patients with multiple relapses, yet the treatment is not without its inconveniences and risks.

“How oncologists and patients balance these relative risks and benefits will shape how these therapies are used; by the time this is sorted out, however, the debate is likely to be moot given the likely use of bispecifics in first-line follicular lymphoma, with CAR T cells reserved for select patients in the second-line and third-line settings,” the authors wrote. “Regardless of sequencing preferences, we are better off for having a multitude of options for patients who need them.”

Reference

Jacobs R, Jacobson C. The treatment of follicular lymphoma with CD19-directed chimeric antigen receptor T-cell therapy. Front Oncol. 2024;14:1384600. doi:10.3389/fonc.2024.1384600