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John Leonard, M.D. Therapies must be carefully considered when treating patients with follicular lymphoma, the most common type of non-Hodgkin lymphoma, says John P. Leonard, M.D., medical oncology, at Weill Cornell Medicine and NewYork-Presbyterian Hospital.

“When patients relapse after initial therapy, the key factors in choosing a treatment include the time from first therapy, the time to reoccurrence, how sick they are, their age and what they need in terms of symptom relief at that time,” says Leonard.

Standard treatment options include single-agent Rituxan (rituximab) and chemotherapy with Rituxan. However, a number of new approaches for indolent lymphoma and more are on the horizon, Leonard says.

In an interview with CURE, Leonard discusses the potential for Revlimid (lenalidomide), Zydelig (idelalisib) and Imbruvica (ibrutinib) in follicular lymphoma, possible combination therapies and challenges that remain in the treatment of the disease.

What upcoming treatment options for indolent lymphoma do you see the most potential for?

There has been some recent data with Revlimid, which is active in follicular lymphoma both alone and combination with Rituxan. There is also Zydelig, a PI3 kinase inhibitor that is FDA approved for refractory follicular lymphoma, and the BTK inhibitor Imbruvica is also active and approved in chronic lymphocytic leukemia (CLL) and mantle cell lymphoma.

There is also the novel approach of venetoclax, which is in clinical trials for follicular lymphoma. In addition, radioimmunotherapy, which has been around for a period of time, and autologous stem cell transplant, which is appropriate for some patients, are other options.

What role do you see Revlimid having for the treatment of follicular lymphoma?

We recently published a paper in the Journal of Clinical Oncology that looked at Rituxan relapse in follicular lymphoma. The overall response rate with single-agent Revlimid was approximately 45 percent and the response duration was about one year. When you add Rituxan to that, the response rate went up to 75 percent, and durability was about two years.

There is an ongoing randomized study known as the AUGMENT trial (NCT01938001), which is looking at single-agent Rituxan versus Rituxan plus Revlimid in recurrent indolent follicular lymphoma and other indolent subtypes. This will help us really determine what the role of Revlimid is versus single-agent Rituxan. 

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