Advancements in Follicular Lymphoma Treatment: BTK Inhibitors and CAR T-Cell Therapies
Advancements in Follicular Lymphoma Treatment
Recent developments in treating follicular lymphoma (FL) are noteworthy. At the 42nd Annual Chemotherapy Foundation Symposium, Dr. Erin Mulvey highlighted promising therapies for patients with relapsed or refractory FL. Treatments like Bruton’s tyrosine kinase (BTK) inhibitors and chimeric antigen receptor (CAR) T-cell therapies are changing the care landscape, showing significant success where traditional treatments have failed.
Targeted Therapies
BTK inhibitors and CAR T-cell therapy are at the forefront of these advancements. BTK inhibitors work by disrupting pathways that help lymphoma cells survive. CAR T-cell therapy involves modifying a patient’s immune cells to target cancer cells. Dr. Mulvey emphasized how these therapies expand treatment options, particularly for patients with challenging cases of FL.
The future looks brighter for FL patients, with ongoing research promising more innovative therapies. These advancements may lead to longer remission times and improved survival rates.
BTK Inhibitors: Zanubrutinib
The BTK inhibitor zanubrutinib (Brukinsa), combined with obinutuzumab (Gazyva), has received FDA approval for FL after satisfying the requirements of the ROSEWOOD study.
In this trial, 217 adult patients with relapsed or refractory FL were analyzed. Participants were assigned to receive zanubrutinib or obinutuzumab alone. The results showed a 68% overall response rate (ORR) in the zanubrutinib group versus 43% with obinutuzumab alone. The complete response (CR) rates were 39% in the experimental group compared to 19% in the control group.
The study’s primary outcome was ORR assessed by independent review, with secondary outcomes including duration of response and progression-free survival (PFS). The DOR at 18 months was 70.9% in the zanubrutinib group; median PFS was significantly longer in the experimental group.
Common toxicities included hematologic issues. The most frequent severe adverse events were thrombocytopenia, pneumonia, diuresis, and others, occurring more often in the zanubrutinib group.
CAR T-Cell Therapy
Dr. Mulvey described results from the ZUMA-5 trial for CAR T-cell therapies. Axi-cabtagene ciloleucel (axi-cel; Yescarta) was particularly noted, with a 94% response rate among patients with relapsed FL. Of these, 79% achieved CR. The median PFS was 40.2 months with a 75% overall survival rate at 36 months.
Patients previously treated with bendamustine had a lower estimated PFS. This finding underscores the importance of treatment history when evaluating outcomes.
Dr. Mulvey pointed out differences between FDA-approved CAR T-cell therapies. The ELARA study with tisagenlecleucel revealed higher risks in certain patient categories compared to axi-cel.
Conclusion
The field of FL treatment shows rapid growth. New therapies increase options for patients who previously had limited choices. As these treatments continue to advance, patients may experience improved outcomes and better management of their disease.