Does rituximab + lenalidomide have a role in advanced follicular lymphoma?

Although bendamustine + rituximab is a standard option for advanced follicular lymphoma when treatment is required, does the regimen rituximab + lenalidomide also have a role? Initial results were quite remarkable while other studies reveal less enthusiastic results (Fowler et al 2014; Leonard et al 2015).

1 Answer

Mednet Member

Medical Oncology · Robert H Lurie Comp Cancer Center of Northwestern University

Answered on

There has been much interest in replacing traditional chemo-immunotherapy (generally R-bendamustine, R-CHOP or R-CVP) with noncytotoxic therapy such as rituximab plus lenalidomide in patients with previously untreated advanced stage follicular lymphoma. Studies in relapsed/refractory patients have shown high response rates as have phase II trials in previously untreated individuals with a range of FLIPI scores. Fowler et al from the MD Anderson reported an 87% CR rate for untreated FL patients with a 3 year PFS of 78.5% while Peter Martin reported a CR rate of 72% with a 2 year PFS of 89%, albeit with short followup, for the cooperative group phase II trial, CALGB 50803. A large international phase 3 trial (RELEVANCE) comparing R-lenalidomide to R-chemotherapy (physician’s choice) has now met accrual and results are eagerly awaited. Long-term followup, especially with regard to secondary malignancies, will be important in this disease when contemplating treatment of patients with an anticipated survival of two decades. For the right patient, this will be an important option if the phase III trial doesn’t show any surprises. Whether this approach will impact the early bad-actor group that has become the focus of much attention recently will also be of great interest.