Update on drugs for Follicular Lymphoma

This article was written by Marc Sorigue, from the Department of Hematology, Hospital German Trias I Pujol in Barcelona, Spain; published in the journal Leukemia Research in August 2016. The main aim of the article was to describe the results obtained with the drugs with the most clinically advanced development in Follicular Lymphoma (FL). The evidence available on these new drugs, which include new monoclonal antibodies, immunoconjugates, the anti-angiogenic and immunomodulatory agent lenalidomide; the proteasome inhibitor bortezomib; inhibitors of B-cell receptor pathway enzymes, such as ibrutinib, idelalisib, duvelisib and entospletinib; BCL2 inhibitors and checkpoint inhibitors.

The main highlights are as follows:

• FL is an incurable disease with a relapsing course
• New drugs targeting B-cell antigens and pathways are rapidly becoming available
• Results with these drugs are encouraging, particularly in refractory patients
• Follow-up is still short and combination regimens remain largely unexplored
• Side-effects, including some unusual toxicities, require caution with their use

Conclusions

Some drugs have shown activity in FL and are in the early stages of development. These drugs were found to be effective in refractory patients who show a dismal prognosis and have very few therapeutic options available to them. However, these new therapies not only continue to present significant toxicities but also demonstrate a different safety profile from that of the classical immunochemotherapy regimes. Currently, follow-ups are short, especially in the front-line setting and in combination with other agents. Therefore it is essential to be cautious with the use of these drugs.

The link to abstract of the article can be found here

New drugs for follicular lymphoma.

Abstract

Despite the improvement in prognosis since the advent of rituximab, follicular lymphoma is still incurable and remains the cause of death of most afflicted patients. With the expanding knowledge of the pathogenesis of B-cell malignancies, in the last few years a plethora of new therapies acting through a variety of mechanisms have shown promising results. This review attempts to analyze the evidence available on these new drugs, which include new monoclonal antibodies and immunoconjugates, the anti-angiogenic and immunomodulatory agent lenalidomide, the proteasome inhibitor bortezomib, inhibitors of B-cell receptor pathway enzymes, such as ibrutinib, idelalisib, duvelisib and entospletinib, BCL2 inhibitors and checkpoint inhibitors. We conclude that despite the high expectations around the new therapeutic options for patients with refractory disease, these new drugs have side effects that require caution with their use, particularly in light of the still short follow up and the lack of both randomized trials and data on combination regimens.