Existing CAR T-cell therapies and emerging BiTEs both show promise in the treatment of follicular lymphoma (FL), according to the authors of a review of emerging therapies and investigational approaches for treating this disease. The paper was published in June in the Journal of Hematology and Oncology.
FL is the second most common subtype of non-Hodgkin lymphoma (NHL), accounting for around 20% of all NHL cases, and the most common subtype of indolent B cell NHL. While 5-year overall survival is 90% for FL patients who remain progression free for more than 24 months, it is just 50% for patients who have progression of disease within 24 months (POD24) after completing first-line hemoimmunotherapy, and about 20% of FL patients have a persistent relapsing course, the authors, Narendranath Epperla, MD, and Walter Hanel, MD, of Ohio State University, write.
Recent studies of axicabtagene ciloleucel (axi-cel) and tisagenlecleucel in FL have shown “impressive” results, they write. In March 2021 the FDA granted accelerated approval to axi-cel for patients with relapsed or refractory FL after 2 or more prior lines of therapy. Although BiTes are not currently approved for FL, early-phase trials with these agents in highly pre-treated FL have shown “promising” results and larger studies are ongoing. The FDA has granted breakthrough therapy designation for mosunetuzumab in FL after 2 prior lines of therapy.
“With the advent of several newer therapies in the second and later line setting, including CAR T therapy and the BiTes, the sequential use of therapies and the decision of when to pursue cel- lular therapy has become much more complex,” the authors write. An important unanswered question is whether CAR T-cell therapy will supplant autologous stem cell transplantation for patients with POD24.
- Hanel W, Epperla N. Evolving therapeutic landscape in follicular lymphoma: a look at emerging and investigational therapies. J Hematol Oncol. 2021;14(1):104. Published 2021 Jun 30. doi:10.1186/s13045-021-01113-2