Published on August 14, 2020
Can Immunotherapy Be Used as a New Treatment for Follicular Lymphoma?
Follicular Lymphoma is a chronic, slow-growing lymphoma and patients are often recommended to "watch and wait." Dr. John Leonard from Weill Cornell Cancer Center joins Patient Power host and advocate, Ruth Fein, to discuss the standard of care for treating follicular lymphoma with chemotherapy. They also discuss how Immunotherapy can be used alone or in combination with chemotherapy as a treatment for follicular lymphoma.
This is Part 1 of a 4-part segment on Follicular Lymphoma. Watch the full discussion in the series below:
Transcript | Immunotherapy for Follicular Lymphoma Treatment
Welcome. I'm Ruth Fein, a patient advocate for Patient Power. I've been living with an MPN, which is a myeloproliferative neoplasm, for about 25 years. And today, we're here to talk about a different blood cancer, which is also a chronic condition and that's follicular lymphoma, which of course is a non-Hodgkin's lymphoma. And we're fortunate to have the wisdom of a world-renowned specialist in the field, Dr. John Leonard, who is Associate Dean for Clinical Research at Weill Cornell Medical Center in New York City. So welcome Dr. Leonard and thanks so much for taking the time to speak to us today.
Thanks. My pleasure to be here, thank you.
To get started, tell us a bit about what the treatment landscape looks like right now.
Sure. Well, follicular lymphoma is really the second most common of the non-Hodgkin lymphomas or over a hundred types of lymphomas in general. Most are B-cell non-Hodgkin lymphomas. And about a third of those, or patients with those entities, have follicular lymphoma. So follicular lymphoma is what we would term a chronic or an indolent or low grade or slow growing lymphoma. And the majority of patients don't die from follicular lymphoma, while some do, most don't. Most people live with follicular lymphoma for many, many years. And so we are treating them at various points in time. I call follicular lymphoma kind of a “hitchhiker lymphoma” where it's along for the ride. Sometimes it's in the trunk of the car. Sometimes it's in the back seat. Sometimes it's in the front seat being annoying, playing with the radio, grabbing the steering wheel.
So often we don't need to treat follicular lymphoma. So that's the first thing that people should know. Commonly, they are approached with a watch and wait approach where patients, if they're feeling well and the disease isn't causing problems, effectively in the trunk of the car, we can observe patients because it turns out that early treatment often does not improve outcomes because people generally do well. That being said, when patients need their initial treatment, for many years it's been chemotherapy.
There are a variety of different chemotherapy regimens. Over the last, roughly 20, almost 25 years, we've used a drug called Rituxan, or rituximab, which is a monoclonal antibody therapy and immune treatment. There are newer versions of rituximab now, but most patients who need their initial treatment with follicular lymphoma get treated either with rituximab by itself or chemotherapy plus rituximab, or one of the newer versions of rituximab as part of that approach. And that tends to be an outpatient treatment that is typically pretty manageable, but it works temporarily, usually for years. And obviously with different chemotherapy regimens, there are pros and cons as far as side effects people need to manage.
I'd like to hear more about your experience. How have immunotherapies impacted the lives of lymphoma patients?
I think that immunotherapies have had a great impact in a couple of different ways. So the first is the idea of an antibody therapy is an antibody. When we get, say the flu virus, you make antibodies against the flu that are immune proteins to help fight the infection. Everyone's paying attention now to their COVID antibodies to see if they've made immune proteins to fight COVID if they've been exposed to it. Well, therapeutic antibodies are antibodies made by a company, a pharmaceutical company in a laboratory, that are engineered to bind to the tumor cells when they're injected into the bloodstream. And in the case of in follicular lymphoma, they can flick switches on the lymphoma cells, help them to die off better, also activated immune response against the lymphoma.
And so that is, it makes chemotherapy work better. It makes other treatments work better. So to that extent it's changed lives because it's improved the effectiveness of therapy. But also it's provided an alternative because immunotherapies don't tend to have the same side effects of chemotherapy. You don't lose your hair. You may not have nausea. They may sometimes, depending on the type, effect the immune system predisposed to infections a bit. But really has a different side effect profile. So the difference really is improving efficacy and providing an option that doesn't have the same kind of side effects as chemotherapy in some fashion.
Right. And we all do everything we can to avoid chemotherapy, whether that's right or wrong. So new therapies are so welcome. And in terms of not just improving symptoms, but potentially improving survival, can you speak to that a little bit more? What have you seen?
Sure. So the long term view in follicular lymphoma is that patients have been living longer over the last several decades. And that is attributable, I think very clearly, to the availability of rituximab or Rituxan, this anti-CD20 monoclonal antibody. And so it has been improving outcomes, meaning that people are living longer, particularly when it is added to chemotherapy. We have newer versions of rituximab that in follicular lymphoma can be a little more effective, can be a little more toxic, whether they translate into long-term improvement in overall survival, meaning how long people live, remains to be seen because people with follicular lymphoma tend to live for decades.
And so, for a new treatment to make a difference in that, you have to often wait decades to see have outcomes and doing better. But that said, certainly the availability of immunotherapies. We also have radioactive versions of the immunotherapies that have been around a long time. They're not used very often, partly because we have other treatments that people tend to find a little more preferable, but that immunotherapy is an important modality for just about everybody with follicular lymphoma.
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