Follicular Lymphoma Chemo Free Precision Therapies : Pre-test

1.

How confident are you in assessing patients for enrollment on clinical trials of BTK inhibitors and other novel therapies and combinations for R/R FL?

A. Not confident
B. Low confidence
C. Moderate confidence
D. Confident
E. Very confident

2.

Patient Case: 72-Yr-Old Woman With Relapsed FL

72-yr-old woman with follicular lymphoma in need of treatment

She received R-CHOP for GCB-DLBCL 10 yr ago

8 yr later, she relapsed with biopsy-confirmed, EZH2 wild-type indolent FL above and below the diaphragm

She received weekly rituximab x 4 cycles with little response, and subsequently transitioned to R², which she took for 10 mo. She achieved a good PR but stopped R² due to progressive fatigue

8 mo after stopping R², she has PD. In addition to diffuse adenopathy with a maximum diameter of 4.5 cm and SUVmax of 8, her LDH is slightly elevated, and her hemoglobin is slightly decreased at 10.8 g/dL

Fatigue improved after stopping R², but it persists to some degree. She is the primary caregiver for her husband, who has early Alzheimer’s disease and dementia, and she’s anxious that he cannot cope without her around

Which of the following is the most accurate statement regarding this patient’s specific situation?

A. She is experiencing early progression after R² and her prognosis is poor; so, she should receive R-ICE and autologous stem cell transplant
B. The rate of grade 2 CRS is low in patients with FL receiving optimized (3 mg on day 15) dosing with epcoritamab
C. Bendamustine + rituximab should be administered, and if that does not work, she should receive T-cell–directed therapy
D. Since she has EZH2 wild-type FL, tazemetostat will not be an effective treatment option

3.

Which of the following approved or emerging agents targets both CD19 and CD3?

A. AZD-0486
B. Epcoritamab
C. Glofitamab
D. Mosunetuzumab
E. Tafasitamab
F. Loncastuximab tesirine

4.

Patient Case: 45-Yr-Old Man With Multiply Relapsed FL

A 45-yr-old man was diagnosed with stage IV, symptomatic disease with splenomegaly and circulating disease

He was treated with R-CHOP for 6 cycles with an initial CR
- He experienced early relapse within 9 mo of completing treatment

He then received obinutuzumab and lenalidomide with an initial partial response but experienced disease progression by Mo 8

Thereafter, he received axi-cel

On Day 4 of treatment, he develops a fever with stable vital signs

On Day 5, he develops hypotension that responds to IV fluid bolus followed by hypoxemia, requiring 3 L of nasal cannula oxygen

What is the next best treatment approach for this patient with grade 2 CRS?

A. Acetaminophen
B. Siltuximab with HD methylprednisolone
C. Supportive care
D. Tocilizumab ± dexamethasone

5.

Patient Case: 73-Yr-Old Woman With FL

A 73-yr-old female with diabetes, labile HTN, and atrial fibrillation is diagnosed with stage III FL after presenting with palpable cervical lymphadenopathy, night sweats, and unintentional weight loss of 20 lb over 3 mo

Bendamustine and obinutuzumabstarted shortly after diagnosis
- No maintenance obinutuzumab due to immunosuppression concerns during COVID pandemic; she tolerated treatment well and achieved a CR

However, ~1 yr after completing therapy, she developed symptoms, and was found to have biopsy-proven relapsed FL

Received second-line therapy with lenalidomide and rituximab (R²)
- Tolerated well, but ultimately had to discontinue lenalidomide after 8 mo because of cytopenias
- FL progressed within 4 mo, with reappearance of cervical lymph nodes and B symptoms

She now lives with her daughter who is unable to bring her to clinic regularly

In your current practice, what approved regimen would you recommend as the optimal next-line treatment for this woman with diabetes, HTN, atrial fibrillation, and transportation challenges?

A. BTK inhibitor monotherapy
B. Brexucabtagene autoleucel
C. Tazemetostat
D. Venetoclax + obinutuzumab
E. Zanubrutinib plus obinutuzumab

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A Game Changer for Follicular Lymphoma: Mastering Use of Precision Therapies as Part of a Chemo-Free Treatment Paradigm

Caron Jacobson, MD

Peter Martin, MD

Sonali M. Smith, MD, FASCO

Pretest

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