Seema Ali Bhat, MD, who is an assistant professor of oncology and a staff physician at the Lymphoma/Myeloma Service at Roswell Park Cancer Institute in Buffalo, New York, said based on recent advances in the understanding of the biology of follicular lymphoma and mantle cell lymphoma, newer treatment options have emerged for both these diseases.
“For patients with mantle cell lymphoma who are 65 or older who are not considered transplant candidates, rituximab maintenance until progression is the new standard of care for up-front treatment. For relapsed/refractory mantle cell lymphoma, newer options are available, like the BTK inhibitor ibrutinib, the proteasome inhibitor bortezomib, and the immunomodulator lenalidomide, all U.S. Food and Drug Administration (FDA)-approved in the recent years for this lymphoma,” Dr Bhat told Cancer Therapy Advisor. “For follicular lymphoma, 1 of the major changes in recent years has been the introduction of maintenance rituximab. Also, the first-in-its-class PI3d kinase inhibitor idelalisib was recently approved by the FDA for the treatment of relapsed follicular lymphoma that has not responded to at least 2 prior systemic therapies.”
Lenalidomide has been shown to boost the immune system and work in the same way as angiogenesis inhibitors. This oral agent is given in cycles of treatment days followed by rest. A typical cycle is 3 weeks of treatment and 1 week of rest. It is hoped that lenalidomide and idelalisib as well as other agents now in development will help improve morbidity and mortality among patients with lymphoma. Dr Bhat said the clinical landscape will be changing dramatically over the next 12 to 24 months.
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“These new options generate excitement amongst investigators to integrate these new therapies rapidly into rational combinations to achieve maximum response rates and disease control and possibly cure and minimize toxicity in the coming years,” said Dr Bhat.
- NCCN Guidelines for Patients. National Comprehensive Cancer Network website. https://www.nccn.org/patients/guidelines/cancers.aspx#nhl. Accessed June 1, 2016.