In a nutshell
The review aimed to assess chemotherapy-free treatment of follicular lymphoma (FL) and marginal zone lymphoma (MZL).
Some background
Standard therapy for slow-growing non-Hodgkin lymphoma (NHL) such as FL and MZL involves immunochemotherapy (ICT). ICT combines immunotherapy and chemotherapy treatments. However, many patients with FL or MZL are not eligible to receive immunochemotherapy due to older age or other significant medical conditions.
Recent advances in the treatment of FL and MZL provide options for a chemotherapy-free management. It is important to review these treatment options.
Methods & findings
This study reviewed chemotherapy-free options for patients with FL and MZL.
Rituximab (Rituxan) is an immunotherapy, an anti-CD-20 monoclonal antibody. As a first-line treatment, regardless of disease burden, rituximab is a safe and effective treatment. A short maintenance period extends the duration of response in these patients.
Radioimmunotherapy using ibritumomab tiuxetan (Zevalin) is safe and effective used as a consolidation treatment after rituximab for older patients who have less than 25% bone marrow involvement.
The combination of rituximab and lenalidomide (Revlimid) is “chemotherapy-free”, but is not better tolerated compared to ICT. Lower doses and a shorter duration of lenalidomide treatment can improve safety without reducing effectiveness for older people.
Low-dose radiation therapy can effectively control extra-nodal MZL. MZL in the spleen has good outcomes when treated with rituximab.
For many patients with relapsed/refractory (R/R) FL/ MZL, simple retreatment with anti-CD20 antibodies such as rituximab will be effective. Other options for R/R disease include ibritumomab tiuxetan, lenalidomide with rituximab, umbralisib (Ukoniq), ibrutinib (Imbruvica) for MZL, and tazemetostat (Tazverik) for FL.
New forms of immunotherapy such as polatuzumab vedotin (Polivy), loncastuximab tesirine (Zynlonta), mosunetuzumab, epcoritamab, and axicabtagene ciloleucel (Yescarta) are still undergoing clinical studies. These suggest that immune-directed approaches produce good responses and limited toxicities in FL/MZL.
The bottom line
This review analyzed available studies regarding chemotherapy-free treatment options available for patients with FL and MZL.
Published By :
Cancer management and research
Date :
May 22, 2021
