SUMMARY
Immunochemotherapy induction followed by maintenance with rituximab (R) is the standard of care (SoC) for patiens (pts) with advanced-stage symptomatic follicular lymphoma (FL), achieving a median progression free survival (PFS) of 6–8 years (yrs) and a median survival (OS) of 12–15 yrs. However, FL is incurable and most pts eventually relapse. Relapse occurs in 30% of pts within 3 yrs, and is associated with a poor prognosis. Obinutuzumab (G) is a glycoengineered type II anti-CD20 monoclonal antibody with enhanced direct cell killing and antibody-dependent cellular cytotoxicity. Promising activity and manageable toxicity when combined with chemotherapy has already been shown in treatment-naïve chronic lymphocytic leukemia (CLL) (G-chlorambucil (Chl)) and in R-refractory indolent non-Hodgkin lymphoma (iNHL). We waited eagerly for the results of GALLIUM, the phase 3 trial which compared G-chemo to R-chemo in advanced, untreated FL. Treatment options for pts with refractory iNHL are limited. Last year, the phase 3 GADOLIN trial, comparing the efficacy and safety of G-bendamustine (B) induction, followed by G maintenance (G-B arm), with B induction (standard in R-refractory iNHL pts), already showed a gain in PFS and time to next treatment (TTNT) for the G-B arm. At this years ASH meeting we learned whether longer follow-up would also show a survival benefit. In previous yrs the outcome of multiple phase 2 and 3 trials with oral B-cell receptor (BCR)-inhibitors in treatment-naïve and relapsed/refractory (R/R) CLL were reported, which led to the approval of these agents for the treatment of CLL. This led to a shift from intravenous chemotherapies, given for a finite number of cycles, to oral therapies given continuously until progressive disease or unacceptable toxicity. Follow-up of these trials is necessary to evaluate long-term efficacy in pts with different prognostic factors and long-term safety.
(BELG J HEMATOL 2017;8(1):23–8)
