Therapeutic Breakthroughs and Latest Updates for the Treatment of Follicular Lymphoma
Andrew Evens, DO, MBA, MSc, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, discusses updates and therapeutic breakthroughs, including CD19 CAR T-cell therapies and CD3-CD20 bispecific antibodies, for the treatment of follicular lymphoma (FL) at the 2025 Lymphoma, Leukemia & Myeloma (LL&M) Winter Symposium in Miami, Florida.
Transcript:
Hi, my name is Dr Andrew Evens from the Rutgers Cancer Institute, and it's great to be here at the LL&M Winter Symposium here in beautiful Miami, Florida.
I was charged with talking about relapsed/refractory follicular lymphoma and the good news is, there's been a lot of good data and breakthroughs in the last several months and couple of years. Of course, a lot of the therapeutic breakthroughs have been anchored on cellular therapy or immunotherapy.
I went through the current active FDA approvals, in particular for CD19 CAR T-cell therapy and the CD3-CD20 bispecific antibodies. There are now 3 CAR T-cell products that are FDA approved for follicular lymphoma in the United States and 2 bispecific antibodies. There's a third that's approved in Europe, odronextamab. But I really focus on the 5 in the US and really went through what is the appropriate patient who, when and how in terms of that treatment and went through the different breakdowns of the 3 CAR T-cell products and the 2 bispecific antibody products.
Of course, as in most situations in lymphoma and cancer, there's not 1 best product for every patient at the time. Now these are currently FDA approved for third-line and beyond. There's a host of clinical studies looking in first relapse and even frontline with these therapies. Of course, the bispecific antibodies, and I don't want to forget about R2 or lenalidomide rituximab, that is a common treatment used in the second-line setting. I went through the different efficacy, side effect panels of these agents. I would say more often than not, I'm using bispecific antibodies as a third-line treatment.
Now, if there's any question of transformation or aggressive disease, I'll probably move up CAR T-cell therapy ahead of the time, and that should always be in the back of the mind with follicular lymphoma. Could there be a transformation? You look for a hotspot on the [standardized uptake value] (SUV) of the PET scan, consider doing a biopsy to prove that.
Then finally, I talked about recent clinical trials that are breaking through. There were a couple presented at the most recent ASH meeting a couple months ago. In particular, the inMIND study that Dr. Laurie Sehn presented, which added tafasitamab to R2, or lenalidomide rituximab, in a blinded, randomized large study. What she presented was a significant progression-free survival (PFS) benefit of more than 50% improvement for the triplet over the doublet. That included patients with 1 relapse or in second line therapy. We'll see how that breaks through if it garners FDA approval.
Then 2 last things. One, a nice single-arm study of the antibody drug conjugate loncastuximab tesirine—that's FDA-approved in diffuse large B-cell—was presented by the Miami group, the Sylvester Comprehensive Cancer Center Group, looking at in relapsed/refractory follicular lymphoma. Many were in first relapse, but a very high overall response of 97% and more than 75% in complete remission. We'll see how that pans out in a multicenter study.
Lastly, and maybe most importantly is quality of life. There was some really good quality of life presentations at ASH, and I highlighted a couple of these. Of course we want to garner a high complete remission, have it durable, but we also want to make sure we're maintaining patients' quality of life, because we know follicular lymphoma patients is a remitting and relapsing disease. That is also paramount as we navigate the care for these patients.
Source:
Evens A. Updates in Treatment of Relapsed Follicular Lymphoma. Presented at Lymphoma, Leukemia & Winter Symposium; February 7-9, 2025. Miami, FL.
