Tycel Phillips, MD, City of Hope Medical Center, Duarte, California, discusses the relationship between line of treatment, treatment site, and response rates among patients with follicular lymphoma (FL) with poor prognosis according to findings from a retrospective observational study he presented at the 65th American Society of Hematology (ASH) Annual Meeting, San Diego, California. 

Transcript:

Hello, my name is Tycel Phillips from City of Hope, Duarte, California. I'd like to thank you for listening in as I present this ASH 2023 abstract, "Real-world response rates across lines of therapy among patients with relapsed or refractory follicular lymphoma."

Just to give a bit of background, follicular lymphoma is the most common non-Hodgkin's lymphoma within the [United States] (US) and Western Europe. The disease as of currently is not curative. Thus, the vast majority of patients will have treatment in the second line and beyond. Today, there [are] not really extended care options in a relapsed/refractory setting, given the incurable nature of the disease and decreasing outcomes responses that we see with subsequent lines of therapy, we wanted to try to get an idea about how community and maybe academic centers are treating patients in the third line and beyond, especially with the advent of some newer therapies, such as chimeric antigen receptor (CAR) therapy and bispecific antibodies. 

We performed a retrospective observational study using the COTA database, which is a database that is comprised of about 50% academic and 50% community from practices within the US. We look for adult patients with a confirmed diagnosis of follicular lymphoma, whether they're on or beyond, who were treated in 2010 or later and had at least 3 months of follow-up in any response assessment after third-line initiation of treatment. From this study, we had accumulated 240 patients with relapsed/refractory third-line beyond follicular lymphoma. We had 140 patients with third-line disease, 55 patients with fourth-line, and 45 patients with fifth-line and beyond.

What we saw in this study was that, sort of to our thoughts, overall responses were higher than those 3rd-line and beyond patients, who were treated in the third-line setting. We saw decreasing overall response rate and complete response rates, with further lines of therapy, so from third to fourth, to fourth to fifth. We also did notice a higher outcome for patients who were treated in academic settings versus those in a community setting. We saw some more common situations [such] as, higher response rates [in] younger patients, which probably speaks of them being able to tolerate more intensive therapies. This also correlated to higher complete response rates. We also saw higher response rates than those with low intermediate [FL International Prognostic Index] (FLIPI) scores versus those with higher FLIPI scores. We saw higher response rates in those who were not considered to be double refractory, meaning refractory to rituximab and chemoimmunotherapy, versus those who were double refractory. 

All in all, this study just gives us a little bit more granular details of patients with relapsed/refractory follicular lymphoma and gives us an idea of their outcomes and response rates based on [the] site of treatment and the line of therapy that they receive treatment in. This confirms what most of us would think as we skip diminishing returns with each subsequent line of therapy. Thus, the earlier patients are treated, the better their outcomes are. 

Now what this does not take into account, is some more novel therapies. Despite, the approval of [rituximab2] R2 and some other novel therapies over the last several years, we did see a higher rate of chemoimmunotherapy utilization, especially in a community setting, and less use of some of these novel therapies, which suggests that if we were to implement some of these more novel therapies into our treatment algorithm, we might see some improvements in response rates and duration response even in these later lines of therapies.

How CAR T[-cell therapy], chimeric antigen receptor therapy, or the bispecific antibodies will play into this picture is yet to be determined. But, again, this also opens up a window for more utilization of these novel therapies. With that, I'd like to thank you for taking the time to listen to me and discuss this abstract. On behalf of all my co-investigators, thank you.

Source: 

Phillips T, Sehn LH, Wang A, et al. Real-world response rates across lines of therapy among patients with relapsed/refractory follicular lymphoma. Presented at the ASH 65th Annual Meeting & Exposition; December 9-12 2023; San Diego, California. Abstract 1683