Analysis of the third-line treatment plan and clinical outcome of ASH US patients with follicular lymphoma in 2021: a real-world study

In the United States and Western Europe, follicular lymphoma (FL) is the second most common lymphoma, accounting for approximately 35% of all non-Hodgkin’s lymphomas (NHL) and 70% of indolent lymphomas
.

The progression-free survival (PFS) rate and overall survival (OS) rate of FL patients who progress to third-line (3L) treatment are lower
.

Currently, treatment options for patients with relapsed or refractory FL (R/R FL) include rituximab (single agent or combination chemotherapy), radioimmunotherapy, PI3K inhibitors, and hematopoietic stem cell transplantation.
CAR-T cells are ≥ The treatment trials of 3L R/R FL patients have also achieved gratifying results, and it is possible to change the treatment mode of these patients
.

The study report of Morrison et al.
showed that combination therapy is the most commonly used (64.
4%) 3L treatment regimen for FL patients, rituximab is the most commonly used single-agent treatment regimen (31.
2%), and bendamustine + rituximab Monoclonal antibody is the most commonly used combination therapy (31.
1%)
.

After 1L treatment, the 2-year OS rate was 86.
9%, and the PFS rate was 64.
6%, but the survival results after 3L treatment were not evaluated
.

As a result, Dong Dai et al.
conducted a study to determine the treatment options used in clinical practice for 3L FL patients in the United States and related clinical results (including the use of PI3K inhibitors in the treatment of R/R FL patients, 1L Disease progression within 24 months after treatment [POD24] clinical results, etc.
)
.

Research method The study used data from the Optum Electronic Medical Record (EHR) database of the United States (a large database of EHR in the United States, involving more than 700 hospitals and more than 7,000 clinics, including the EHR of more than 80 million patients) for a non-interventional retrospective analyze
.

This analysis identified and evaluated adult patients (≥18 years of age) who were diagnosed with FL between January 1, 2008 and December 31, 2019
.

The primary endpoints are time to progression (DLBCL conversion, start of new follow-up treatment [LOT] or supportive care), OS and PFS, and key secondary endpoints are time to next treatment (TTNT) and treatment mode
.

Study Results 1 Baseline Demographics and Clinical Characteristics The study finally included 687 patients with an average age of 62.
9 years (range: 18-86).
46.
9% of the patients were female, 87.
3% were white, and 92.
1% were non- Hispanic
.

The median Charlson comorbidity index (CCI) was 3 (range: 1-18), and chronic lung disease (24.
2%) was the most common comorbidity (except for malignant tumors)
.

2 Clinical results The median time to progression of 3L-treated patients in the overall cohort was 16.
6 (95% Cl: 14.
4, 18.
1) months
.

The median PFS was 12.
5 (95% Cl: 11.
3, 14.
4) months
.

The 1-year, 2-year, and 5-year PFS rates were 51.
1%, 29.
8%, and 16.
1%, respectively
.

The median OS was not reached, and the 1-year, 2-year, and 5-year OS rates were 83.
1%, 74.
8%, and 61.
4%, respectively
.

The median time to progression of patients treated with 3L rituximab was 19.
1 (95% Cl: 16.
7, 21.
7) months
.

The median PFS was 15.
7 (95% Cl: 14.
2, 17.
5) months
.

The 1-, 2-, and 5-year PFS rates were 58.
7%, 34.
3%, and 18.
8%, respectively
.

The median OS was not reached, and the 5-year OS rate was 67%
.

In the 3 subgroup analysis of patients with POD24, non-POD24, and index dates after 2014 (including 2014), the results of 3L treatment were similar to the results of the overall cohort
.

In the Cox regression model adjusted for baseline characteristics (age, gender, region, and CCI), there was no statistically significant difference in the time to progression, OS, PFS, and TTNT between POD24 and non-POD24 patients with 3L treatment
.

The median time to progression, PFS and TTNT for POD24 and non-POD24 patients were 15.
7 months and 17.
9 months, 11.
6 months and 15.
2 months, 18 months and 17.
9 months, respectively
.

4 Therapeutic mode The treatment regimen containing rituximab (73.
7%) is the most common in 3L treatment (38.
4% for single agent, 35.
2% for combination therapy)
.

Six patients (0.
87%) were treated with otuzumab combination therapy in the 3L treatment
.

3.
1%, 2.
2% and 1.
9% of patients were treated with bendamustine, Pl3K inhibitor and lenalidomide monotherapy
.

1.
6% of patients were treated with R2 (rituximab and lenalidomide) regimen in 3L treatment
.

The treatment regimen containing rituximab is also the most commonly used 1L, 2L and 4L treatment regimen
.

In the overall cohort, the median TNTT for 3L treatment was 18 (95% Cl: 15.
8, 19.
9) months, and there was a 6-month gap between PFS and TTNT
.

The median TTNT of rituximab-treated patients was 18.
8 (95% Cl: 17, 21.
7) months
.

The study concluded that 49.
2% of FL patients did not receive 4L treatment after receiving 3L treatment
.

The treatment regimen containing rituximab is the most common 3L treatment regimen for FL patients
.

A small proportion of patients were treated with bendamustine, PI3K inhibitors and lenalidomide monotherapy
.

R2 is used by a small number of patients for 3L treatment, but since it was approved in 2019, it has become an important option for FL treatment
.

Since the median PFS at each time point is not more than 12.
5 months, most of the observed results are poor.
New drugs that are undergoing clinical trials can provide doctors with new treatment options to balance treatment effects and safety with patients’ lives Quality
.

Reference source: Dong Dai, et al.
2021ASH.
Abstract#1360.
Stamp "read the original text", we make progress together