Follicular Lymphoma News at ASH 2018: An Update From Dr. Peter Martin

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Topics include: Treatments and Understanding

From the 2018 American Society of Hematology (ASH) annual meeting in San Diego, Patient Power founder Andrew Schorr is joined by leading lymphoma specialist Dr. Peter Martin, from Weill Cornell Medical Center, to discuss follicular lymphoma treatment news announced at the conference. Dr. Martin gives an important update on the expanding treatment landscape; oral regimens, BTK inhibitors, P13-Kinase inhibitors and more. Dr. Martin also shares a message of hope for patients coping with a follicular lymphoma diagnosis. Watch now to stay up-to-date with the latest research.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Andrew Schorr here in San Diego at the American Society of Hematology meeting.  Follicular lymphoma, people are living longer and living better, and there continues to be progress.  With me is a lymphoma specialist from Weill Cornell medicine, New York City, Dr. Peter Martin.  Dr. Martin, a positive time for people with follicular lymphoma? 

Dr. Martin:

Definitely, definitely a positive time.  I think that with follicular lymphoma we're learning more and more about the fact that most people with follicular lymphoma will live literally for decades with lymphoma, and so figuring out what kinds of treatments will allow people to enjoy life with minimal interference from lymphoma but also with minimal interference from the treatment of lymphoma is becoming really critical, right? 

And one thing I think we're seeing is that the more treatments that become available the more sort of options we have to try to figure out what is the right treatment under that setting.  Yesterday we saw three different lenalidomide-based (Revlimid) treatments presented in the front-line setting.  There was lenalidomide—in follicular lymphoma, lenalidomide plus rituximab (Rituxan) in the relapsed setting. 

Dr. John Leonard, a colleague and mentor of mine, presented data from the Augment Trial showing that the addition of lenalidomide to rituximab in people with previously treated follicular lymphoma can have a significant improvement in outcomes, not just progression-free survival but also overall survival, which is—when that happens in follicular lymphoma we have to pay attention to it, right?  That's doesn't happen all the time.  There's a reason for that. 

We also saw data with lenalidomide plus obinutuzumab (Gazyva), another anti-CD20 antibody that may under certain circumstances be more effective than rituximab.  That looked promising.  We saw data from Loretta Nastoupil from MD Anderson looking at the combination of lenalidomide, rituximab, ibrutinib (Imbruvica).  It's clearly an active regimen.  There are good things and bad things about it. 

So I think we're—as we get more and more experience with these different treatments figuring out how and when to use them is going to be a really interesting kind of—it's a really interesting time to be working with these drugs. 

Andrew Schorr:

And what about oral drugs that are being used in a somewhat related condition, CLL, chronic lymphocytic leukemia, whether it's a BTK inhibitor or one of these other inhibitors, these oral therapies, could that play a role? 

Dr. Martin:

Sure.  So, well, first of all, lenalidomide is an oral therapy so that's already…

Andrew Schorr:

For myeloma. 

Dr. Martin:

…for myeloma, right.  And it is approved for mantle cell lymphoma as well, and interestingly it does also have activity in CLL, so it's a broadly active drug.  But, you're right, ibrutinib, a BTK inhibitor is approved for multiple lymphomas, not for follicular lymphoma, and there's a reason for that.  By itself it really does not have the activity that other agents have in follicular lymphoma, and so although occasionally it will be used most of the time there are probably other options that are maybe more appropriate. 

There are some agents that do work well in CLL and follicular lymphoma that are oral, like idelalisib (Zydelig) and other agents in that class called PI 3-kinase inhibitors.  Now in follicular lymphoma we have three that are approved, idelalisib, co-pan list I object, duvelisib (Copiktra).  There are others that are in development.  Again, it's an interesting class of agents with clear activity in follicular lymphoma.  Trying to figure out the best patient population for that class of agents and how to use them most appropriately I think is something that we're dialing down on right now and a number of clinical trials will help us with that. 

Andrew Schorr:

So the idea for someone living with it, whether it's themselves or a family member, is, I think, to have an active dialogue, and first of all have hope that you can live a long life and also to have an active dialogue with your doctor as this landscape is changing. 

Dr. Martin:

Absolutely.  You know, again, it's—there's something about follicular lymphoma that's challenging, right?  Nobody ever celebrates a diagnosis of lymphoma.  That is not typical, but there's something about being able to help people over time recognize that life goes on and there's a very good chance that life will go on just as it would have had this lymphoma not arisen, right? 

So that's powerful.  It's a powerful experience.  I tell people this is not your excuse to go buy a Lamborghini and start bungee jumping, right?  Your life is going to continue.  And that kind of knowledge helps people to move on, and then we go from there to again try to pick the treatments that are going to hopefully keep the lymphoma out of their life and help keep me out of their life as much as possible too. 

Andrew Schorr:

Okay.  Thank you for your devotion to lymphoma patients.  Dr. Peter Martin from Weill Cornell medicine.  And again a very upbeat story for people living a long, full life with follicular lymphoma. 

I'm Andrew Schorr for Patient Power in San Diego.  Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on January 8, 2019