Current Therapeutic Strategies and New Treatment Paradigms for Follicular Lymphoma

Abstract

Follicular lymphoma (FL) is an indolent non-Hodgkin's lymphoma that remains an incurable disease for most patients. It is responsive to a variety of different treatments, however it follows a pattern of relapsing and remitting disease. Traditional therapeutic options for patients with untreated FL include expectant observation for asymptomatic and low tumor burden and multiagent cytotoxic chemotherapy for symptomatic and/or high tumor burden. Biologics have become an integral part of therapy with agents that target B lymphocytes, including monoclonal anti-CD20 antibodies and radiolabeled anti-CD20 antibodies. Treatment response to cytotoxic and biologic therapy is high initially; however, with subsequent treatments, response rate and remission duration typically decline and cumulative toxicities increase. The identification of novel targeted agents, use of stem cell transplantation, and new treatment combinations provide the opportunity to enhance patient outcomes. In this review, we critically examine standard treatment strategies for patients with newly diagnosed and relapsed or refractory FL and discuss established and emerging novel therapeutic approaches.

Harnessing T cells to fight cancer with BiTE® antibody constructs – past developments and future directions

“…While there are many unmet medical needs in DLBCL, a number of new targeted agents are available for the treatment of FL and CLL . Nonetheless, distinct patient populations, including those with p53 mutations and those that relapse within the first year of therapy, have a particularly poor prognosis .…”

Safety and activity of ibrutinib in combination with durvalumab in patients with relapsed or refractory follicular lymphoma or diffuse large B‐cell lymphoma

“…Diffuse large B‐cell lymphoma (DLBCL) and follicular lymphoma (FL) are the most common subtypes of non‐Hodgkin lymphoma in adults . Although most patients respond to first‐line chemoimmunotherapy, a substantial proportion of patients with DLBCL and most patients with FL will eventually relapse or have refractory disease .…”

“…Diffuse large B‐cell lymphoma (DLBCL) and follicular lymphoma (FL) are the most common subtypes of non‐Hodgkin lymphoma in adults . Although most patients respond to first‐line chemoimmunotherapy, a substantial proportion of patients with DLBCL and most patients with FL will eventually relapse or have refractory disease . The treatment of relapsed/refractory DLBCL and FL remains challenging, with a minority of patients with DLBCL achieving durable remission and patients with FL experiencing decreased duration of remission with successive therapies .…”

Idelalisib for the treatment of non-Hodgkin lymphoma

“…Patients and clinicians are, appropriately, increasingly de-prioritizing high-intensity therapies for relapsed iB-NHL including stem cell transplantation in favor of “stitching together” targeted therapies that bring substantially less upfront risk [69]. Importantly, however, targeted therapies including idelalisib are non-curative and likely to ultimately exhaust their efficacy in younger patients undergoing treatment for iB-NHL.…”