eCase - Advances in FL

Introduction

In this module, John M. Burke, MD, and Jean L. Koff, MD, MSc, discuss findings from key clinical trials investigating new and emerging immunotherapeutic approaches for treating patients with relapsed/refractory (R/R) follicular lymphoma (FL) and incorporating these therapies into practice.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. A few questions will be asked twice: once at the beginning of the activity and then again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

For those providing patient care, how many patients with FL do you provide care for in a typical month?

A.
1-4
B.
5-10
C.
11-15
D.
16-20
E.
>20
F.
Not applicable

Which of the following results has been reported with the use of approved CAR T-cell therapy (axicabtagene ciloleucel or tisagenlecleucel) in patients with R/R FL?

A.
An overall response rate (ORR) of approximately 60% with both therapies
B.
An incidence of grade ≥3 cytokine-release syndrome (CRS) of approximately 20% with both therapies
C.
A median progression‑free survival (PFS) of approximately 3.5 years with axicabtagene ciloleucel
D.
Most patients achieving a partial response (PR) converted to a complete response (CR) with tisagenlecleucel

In addition to premedication with corticosteroids, antihistamine, and an antipyretic, which of the following is the recommended strategy to reduce CRS risk when treating a patient with R/R FL with the bispecific antibody mosunetuzumab-axgb?

A.
Weekly step-up dosing in cycle 1, followed by mandatory 24-hour hospitalization once full dose is reached
B.
Weekly step-up dosing in cycle 1 to the first full dose; hospitalization is not mandatory
C.
Step-up dosing at each cycle across cycles 1-3, followed by mandatory 24-hour hospitalization once the full dose is reached
D.
Step-up dosing at each cycle across cycles 1-3 to the first full dose; hospitalization is not mandatory

A 77-year-old man was diagnosed with noncontiguous stage III FL. He received obinutuzumab plus cyclophosphamide/doxorubicin/vincristine/prednisone (O-CHOP) chemotherapy and had progressive disease after 15 months. Second-line therapy was initiated with lenalidomide and rituximab (R2). Eight months after completing the therapy, he developed symptoms, and biopsy confirmed relapsed FL. He has a past medical history of type 2 diabetes (A1C 7.3%) but is otherwise healthy and spends a lot of time with his adult son and grandchildren. During his consultation, he states, “I am concerned about these multiple recurrences and want a therapy I can start right away that isn’t associated with other malignancies.” Which of the following therapies would you recommend for this patient?

A.
Rituximab (R)-CHOP and rituximab maintenance
B.
Copanlisib
C.
Mosunetuzumab-axgb
D.
Tazemetostat
E.
Tisagenlecleucel
F.
Uncertain

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Current and Emerging Therapeutic Advances in Follicular Lymphoma: A Class in Session

John M. Burke, MD

Jean Louise Koff, MD, MSc

Activity

Introduction

For those providing patient care, how many patients with FL do you provide care for in a typical month?

Which of the following results has been reported with the use of approved CAR T-cell therapy (axicabtagene ciloleucel or tisagenlecleucel) in patients with R/R FL?

In addition to premedication with corticosteroids, antihistamine, and an antipyretic, which of the following is the recommended strategy to reduce CRS risk when treating a patient with R/R FL with the bispecific antibody mosunetuzumab-axgb?