Which targeted therapy leads to the best quality of life for advanced FL?

This study looked at the quality of life for patients with advanced follicular lymphoma (FL) who were treated with obinutuzumab (Gazyva) and chemotherapy compared to those treated with rituximab (Rituxan) and chemotherapy. It found that both targeted antibody therapies improved quality of life for patients with advanced FL.

FL is a slow-growing cancer of B cells, which are a type of white blood cell. FL cannot be cured, but it can be controlled for years. Therefore, quality of life during treatment is particularly important for patients with FL.

Antibody therapies have improved FL outcomes compared to chemotherapy alone. Antibodies are small molecules used by the immune system which can attach to a specific target. Rituximab and obinutuzumab are both antibody therapies that attach to the surface of B cells. Both antibody therapies trigger FL cancer cells to undergo self-destruction. New, healthy B cells develop in the bone marrow to replace these white blood cells. 

An earlier study found that patients treated with obinutuzumab were less likely to have the FL progress (worsen) compared to those treated with rituximab. This study uses the same data to determine how the quality of life is affected by these antibody therapies.

This study followed 1202 patients with previously untreated advanced FL. Half the patients randomly received obinutuzumab, and the other half received rituximab. All of the patients were also treated with 6 to 8 cycles of chemotherapy. For patients whose cancer responded, the antibody therapy was continued for two years or until the FL worsened. This study includes results through month 48 after maintenance treatment ended. This was up to 84 months after the start of treatment.

After four years, fewer of the patients treated with obinutuzumab had their cancer progress (78.1% vs. 67.2%). 

The patients’ quality of life was evaluated using the Functional Assessment of Cancer Treatment-Lymphoma. This questionnaire addresses physical, emotional, and social well-being. Most patients completed the questionnaire at all of the measurement times (92.7% and 91.2%). 

The total quality of life scores were similar for both treatment groups at all measurement times. The researchers determined that a 7 point increase of the total questionnaire represents a meaningful improvement in the patient’s quality life. A third of patients had a clinically meaningful improvement by the third cycle of chemotherapy. Roughly half of patients had a clinically meaningful improvement in quality of life by the second month of maintenance (49.7% vs. 48.0%).  Patients retained this higher quality of life through the end of the assessments at month 48.

This study found that both obinutuzumab and rituximab led to an improvement in quality of life when used with chemotherapy. The improvement was similar for both treatments.

Which chemotherapy medicines were used varied depending on which of the study sites the patient was treated at. The study did not adjust for this difference.