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Follicular lymphoma (FL) is one of the most common B-cell non-Hodgkin lymphomas (B-NHL), and the incidence is increasing year by year
.
With the launch of many targeted drugs and the rise of the concept of precision therapy, good progress has been made in the clinical treatment of FL
.
Among them, the targeted drugs represented by a new generation of anti-CD20 monoclonal antibody-octuzumab have relatively significant efficacy in the field of FL, and it is of great significance to explore its role in the era of precision therapy
.
Based on this, Yimaitong specially invited Professor Liu Lin and Professor Tang Xiaoqiong from the First Affiliated Hospital of Chongqing Medical University to discuss the precise targeted therapy of FL, and explore the application of otuzumab in the field of FL under the fine stratification strategy
.
Yimaitong: FL is one of the more common blood system diseases.
What problems do you think need to be solved urgently in the treatment of FL? Professor Liu Lin's FL is one of the common clinical indolent lymphomas, and the clinical attention is poor
.
With the continuous in-depth understanding of the disease, the clinic gradually realized that FL is not an "indolent" tumor in the traditional sense.
challenge
.
In clinical practice, reasonable treatment strategies are generally selected through stratified treatment in order to prolong the survival of FL patients
.
In recent years, with the continuous emergence of new drugs such as BTK inhibitors and BCL-2 inhibitors, the survival of FL patients has improved, but the efficacy of the drugs is not satisfactory, especially for relapsed and refractory FL
.
For FL clinics, it is very important for doctors to have a deeper understanding of the disease and to make precise treatment arrangements for patients
.
Professor Tang Xiaoqiong and Professor Liu Lin expounded the current status of FL treatment and related problems in general
.
It needs to be added that, combined with the characteristics of China's population structure, with the increase in the degree of aging, the number of FL patients in China is increasing year by year, which brings a certain burden to patients and society
.
In traditional cognition, FL has indolent characteristics, but with the in-depth understanding of the disease, it is recognized that some early FL is aggressive and the transformation speed is fast, and there is currently no excellent clinical treatment for this type of FL
.
In addition, 30-40% of FL patients may eventually transform into highly aggressive diffuse large B-cell lymphoma (DLBCL), which has a poor prognosis and is more difficult to treat
.
How to prolong the progression-free survival (PFS) and overall survival (OS) of FL patients with poor prognosis and develop better treatment strategies for the patients are still several major challenges
.
Yimaitong: The clinical treatment plan for FL has attracted much attention.
Could you please introduce the evolution history of the treatment plan for FL
.
With the in-depth understanding of the disease mechanism and the rise of the concept of pathological stratification, Professor Liu Lin not only performed clinical staging of FL according to the traditional standards, but also based on the clinical reality, starting from the molecular pathogenesis, not sticking to staging standards, and striving Make patient stratification more refined
.
The application of rituximab in 1997 changed the whole treatment pattern of B-cell lymphoma, and the subsequent R-CHOP program (rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone) was started A new era of lymphoma immunotherapy
.
Currently, radiotherapy is the main clinical treatment for limited-stage FL, and involved field radiotherapy combined with CD20 monoclonal antibody is the main treatment method
.
For advanced FL, R-CHOP regimen, BR regimen (rituximab combined with bendamustine) or even no chemotherapy regimen R2 (rituximab combined with lenalidomide) are mainly used clinically, followed by sequential maintenance treat
.
For relapsed and refractory FL, many clinical studies have been carried out, and related trials have been carried out using targeted drugs such as otuzumab, EZH2 inhibitors, BTK inhibitors, PI3K inhibitors, bispecific antibodies, PD-1 antibodies, etc.
.
Among them, based on the global classic research GALLIUM, a new generation of anti-CD20 monoclonal antibody, ottuzumab, which was recently launched in China, has better efficacy than rituximab, and is better than small molecule inhibitors in reducing drug resistance and other aspects
.
Ortuzumab in combination with chemotherapy can be used as a subsequent single-agent maintenance therapy in treatment-naïve adult patients with stage II FL with bulky, stage III or IV FL, and in patients with at least a partial response (PR)
.
Yimaitong: At present, ortuzumab has been approved in China for the treatment of newly diagnosed FL patients.
Could you please introduce the characteristics of ortuzumab and compare with rituximab, ortuzumab? What are the advantages of monoclonal antibodies? Prof.
Tang Xiaoqiong Ortuzumab is the first type II anti-CD20 monoclonal antibody with humanized glycosylation modification.
Its direct cell killing (DCD) and antibody-dependent cytotoxicity (ADCC) are better than those of rituximab.
enhanced
.
The phase II GAUSS study compared the efficacy and safety of octuzumab and rituximab in patients with CD20-positive indolent B-cell lymphoma, including FL
.
The results of the study showed that octuzumab had a higher overall response rate (ORR) than rituximab (44.
6% vs 33.
3%) in patients with FL, and had a better safety profile
.
In addition, the GALLIUM study further explored the efficacy of octuzumab in treatment-naïve FL
.
This study compared the efficacy of ortuzumab (G) plus chemotherapy with conventional rituximab (R) plus chemotherapy in previously untreated CD20-positive FL patients
.
RESULTS: Compared with R-chemotherapy, G-chemotherapy reduced the risk of progression, recurrence, and death by 34% in patients with follicular lymphoma, and reduced the relative risk of progressive disease (POD24) events within 24 months 46%
.
Due to the significant efficacy of octuzumab in the treatment of FL, major authoritative guidelines have included octuzumab combined with chemotherapy as the first-line treatment recommendation for FL
.
Yi Mai Tong: Precise and individualized treatment is the focus of the current treatment of follicular lymphoma.
Please introduce the importance of FL precise targeted therapy and how to achieve precise and individualized treatment of FL
.
Professor Tang Xiaoqiong's FL treatment process should implement individualized and whole-process management
.
During clinical diagnosis, comprehensive evaluation should be made according to the patient's general condition and pathological analysis, and corresponding treatment strategies should be selected for patients with different stages or stratifications
.
Taking octuzumab as an example, because its efficacy and safety are better than traditional rituximab, when clinically encountering patients with FL in the corresponding stage, octuzumab should be used for active treatment according to the guidelines recommended
.
With the implementation of the refined stratification strategy, genetics, genetics and other indicators have been gradually added to the FL clinical assessment process, making FL stratification and grading more accurate
.
In this context, ortuzumab can rely on its targeting characteristics to better treat relapsed and refractory FL patients and bring better survival benefits to such patients
.
Professor Liu Lin and Professor Tang explained the significance of precision therapy for FL based on guidelines and clinical research.
In fact, precision therapy for lymphoma is similar to shooting.
Only by accurately finding the bullseye can the target be more accurately hit
.
Therefore, refined clinical staging is particularly important for the treatment of FL
.
The previous FL staging was mainly based on morphology, immunohistochemical analysis, etc.
, and the boundaries were blurred
.
Later, the emergence of genetic analysis, molecular typing and other methods promoted the refined staging of FL
.
The current clinical practice should consider organically combining the four dimensions of morphology, genetics, immunology, and molecular biology, comprehensively and comprehensively assess the patient's condition under a refined framework, and implement fixed-point "breakthroughs" for effective treatment
.
Precision therapy requires not only a clear and precise stratification strategy, but also the support of related drugs
.
The fine stratification strategy avoids the "one-size-fits-all" approach to a certain extent.
With the support of this strategy, otuzumab can better serve the clinic, such as the treatment of relapsed and refractory FL patients for which there is no unified clinical treatment plan.
.
The clinical goal is to continuously bring better survival benefits to patients.
Under the current background of precision treatment, workers in the field of FL should make concerted efforts to continuously explore how to better apply otuzumab to FL clinical practice
.
Yimaitong: Ortuzumab was approved for the treatment of FL in China.
What changes will this bring to the treatment landscape of FL? Please share your views? Prof.
Liu Lin has been on the market in China for more than 20 years.
It is undeniable that many FL patients have benefited from this
.
The subsequent launch of a new anti-CD20 monoclonal antibody, ortuzumab, shows the potential to create a new pattern of FL treatment
.
Many studies have shown that the efficacy of ortuzumab combined with chemotherapy in the treatment of FL patients is significantly better than that of traditional rituximab combined with chemotherapy, and the quality of life of patients has also improved
.
It is gratifying that Ortuzumab has now entered China's National Medical Insurance Drug List, and many Chinese FL patients are expected to receive Ortuzumab treatment without having to look at the "O"
.
As octuzumab enters the medical insurance system, its application will be more extensive, and more patients will benefit from it
.
In order to achieve this goal, the state, society, relevant pharmaceutical companies, clinicians, etc.
should work together to actively promote the application of octuzumab in the real world.
The day when octuzumab is widely used may reshape the treatment landscape for FL.
time
.
Dr.
Liu Lin, Professor, Doctoral Supervisor, Chief Physician, Chief Physician, Chief Physician, Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, National Member, Hematology Branch, Chinese Medical Association Member, Hematologist Branch, Chinese Medical Doctor Association Member of the Hematopoietic Stem Cell Application Group of the Hematology Branch of the Chinese Medical Association Consultant of the Anti-Infection Group of the Hematology Branch of the Chinese Medical Association Member of the Lymphoma Alliance of the Chinese Anti-Cancer Association Member of the Standing Committee of the Hematology Professional Committee of the Chinese Medical Education Association Member of the Standing Committee of the Session of the Committee, Chairman of the Hematology and Oncology Committee of Chongqing Anti-Cancer Association, Vice Chairman of the Chongqing Hematology Committee Talents, famous teachers, won the National Natural Science Foundation of China, the key projects of Chongqing Municipal Science and Technology Commission and many other projects
.
He has published more than 70 papers at home and abroad, and is the deputy editor of 2 monographs by Prof.
Tang Xiaoqiong, MD, professor and master tutor, chief physician of the First Affiliated Hospital of Chongqing Medical University, member of the Hematology Rehabilitation Professional Committee of the Chinese Association of Rehabilitation Medicine, and Lymphoma of the Chongqing Anti-Cancer Association.
Member of the Standing Committee of the Committee Member of the Midwest Immune Deficiency Related Lymphoma Diagnosis and Treatment Collaborative Group of the China Anti-Lymphoma Alliance Member and Secretary of the Chongqing Chronic Lymphocytic Leukemia Working Group Member and Secretary of the Precision Medicine and Molecular Diagnosis Committee of the Chongqing Association of Integrative Medicine Committee member The member of the Professional Committee of Oncology and Cardiology of Chongqing Anti-Cancer Association has been engaged in the medical treatment, teaching and scientific research of hematological diseases for a long time.
Hematopoietic stem cell transplantation and oncology cardiology, funded by many projects, published dozens of academic papers in domestic and foreign core journals Scan the QR code below to enter the "Mystery Exploration" channel "Channel!
.
With the launch of many targeted drugs and the rise of the concept of precision therapy, good progress has been made in the clinical treatment of FL
.
Among them, the targeted drugs represented by a new generation of anti-CD20 monoclonal antibody-octuzumab have relatively significant efficacy in the field of FL, and it is of great significance to explore its role in the era of precision therapy
.
Based on this, Yimaitong specially invited Professor Liu Lin and Professor Tang Xiaoqiong from the First Affiliated Hospital of Chongqing Medical University to discuss the precise targeted therapy of FL, and explore the application of otuzumab in the field of FL under the fine stratification strategy
.
Yimaitong: FL is one of the more common blood system diseases.
What problems do you think need to be solved urgently in the treatment of FL? Professor Liu Lin's FL is one of the common clinical indolent lymphomas, and the clinical attention is poor
.
With the continuous in-depth understanding of the disease, the clinic gradually realized that FL is not an "indolent" tumor in the traditional sense.
challenge
.
In clinical practice, reasonable treatment strategies are generally selected through stratified treatment in order to prolong the survival of FL patients
.
In recent years, with the continuous emergence of new drugs such as BTK inhibitors and BCL-2 inhibitors, the survival of FL patients has improved, but the efficacy of the drugs is not satisfactory, especially for relapsed and refractory FL
.
For FL clinics, it is very important for doctors to have a deeper understanding of the disease and to make precise treatment arrangements for patients
.
Professor Tang Xiaoqiong and Professor Liu Lin expounded the current status of FL treatment and related problems in general
.
It needs to be added that, combined with the characteristics of China's population structure, with the increase in the degree of aging, the number of FL patients in China is increasing year by year, which brings a certain burden to patients and society
.
In traditional cognition, FL has indolent characteristics, but with the in-depth understanding of the disease, it is recognized that some early FL is aggressive and the transformation speed is fast, and there is currently no excellent clinical treatment for this type of FL
.
In addition, 30-40% of FL patients may eventually transform into highly aggressive diffuse large B-cell lymphoma (DLBCL), which has a poor prognosis and is more difficult to treat
.
How to prolong the progression-free survival (PFS) and overall survival (OS) of FL patients with poor prognosis and develop better treatment strategies for the patients are still several major challenges
.
Yimaitong: The clinical treatment plan for FL has attracted much attention.
Could you please introduce the evolution history of the treatment plan for FL
.
With the in-depth understanding of the disease mechanism and the rise of the concept of pathological stratification, Professor Liu Lin not only performed clinical staging of FL according to the traditional standards, but also based on the clinical reality, starting from the molecular pathogenesis, not sticking to staging standards, and striving Make patient stratification more refined
.
The application of rituximab in 1997 changed the whole treatment pattern of B-cell lymphoma, and the subsequent R-CHOP program (rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone) was started A new era of lymphoma immunotherapy
.
Currently, radiotherapy is the main clinical treatment for limited-stage FL, and involved field radiotherapy combined with CD20 monoclonal antibody is the main treatment method
.
For advanced FL, R-CHOP regimen, BR regimen (rituximab combined with bendamustine) or even no chemotherapy regimen R2 (rituximab combined with lenalidomide) are mainly used clinically, followed by sequential maintenance treat
.
For relapsed and refractory FL, many clinical studies have been carried out, and related trials have been carried out using targeted drugs such as otuzumab, EZH2 inhibitors, BTK inhibitors, PI3K inhibitors, bispecific antibodies, PD-1 antibodies, etc.
.
Among them, based on the global classic research GALLIUM, a new generation of anti-CD20 monoclonal antibody, ottuzumab, which was recently launched in China, has better efficacy than rituximab, and is better than small molecule inhibitors in reducing drug resistance and other aspects
.
Ortuzumab in combination with chemotherapy can be used as a subsequent single-agent maintenance therapy in treatment-naïve adult patients with stage II FL with bulky, stage III or IV FL, and in patients with at least a partial response (PR)
.
Yimaitong: At present, ortuzumab has been approved in China for the treatment of newly diagnosed FL patients.
Could you please introduce the characteristics of ortuzumab and compare with rituximab, ortuzumab? What are the advantages of monoclonal antibodies? Prof.
Tang Xiaoqiong Ortuzumab is the first type II anti-CD20 monoclonal antibody with humanized glycosylation modification.
Its direct cell killing (DCD) and antibody-dependent cytotoxicity (ADCC) are better than those of rituximab.
enhanced
.
The phase II GAUSS study compared the efficacy and safety of octuzumab and rituximab in patients with CD20-positive indolent B-cell lymphoma, including FL
.
The results of the study showed that octuzumab had a higher overall response rate (ORR) than rituximab (44.
6% vs 33.
3%) in patients with FL, and had a better safety profile
.
In addition, the GALLIUM study further explored the efficacy of octuzumab in treatment-naïve FL
.
This study compared the efficacy of ortuzumab (G) plus chemotherapy with conventional rituximab (R) plus chemotherapy in previously untreated CD20-positive FL patients
.
RESULTS: Compared with R-chemotherapy, G-chemotherapy reduced the risk of progression, recurrence, and death by 34% in patients with follicular lymphoma, and reduced the relative risk of progressive disease (POD24) events within 24 months 46%
.
Due to the significant efficacy of octuzumab in the treatment of FL, major authoritative guidelines have included octuzumab combined with chemotherapy as the first-line treatment recommendation for FL
.
Yi Mai Tong: Precise and individualized treatment is the focus of the current treatment of follicular lymphoma.
Please introduce the importance of FL precise targeted therapy and how to achieve precise and individualized treatment of FL
.
Professor Tang Xiaoqiong's FL treatment process should implement individualized and whole-process management
.
During clinical diagnosis, comprehensive evaluation should be made according to the patient's general condition and pathological analysis, and corresponding treatment strategies should be selected for patients with different stages or stratifications
.
Taking octuzumab as an example, because its efficacy and safety are better than traditional rituximab, when clinically encountering patients with FL in the corresponding stage, octuzumab should be used for active treatment according to the guidelines recommended
.
With the implementation of the refined stratification strategy, genetics, genetics and other indicators have been gradually added to the FL clinical assessment process, making FL stratification and grading more accurate
.
In this context, ortuzumab can rely on its targeting characteristics to better treat relapsed and refractory FL patients and bring better survival benefits to such patients
.
Professor Liu Lin and Professor Tang explained the significance of precision therapy for FL based on guidelines and clinical research.
In fact, precision therapy for lymphoma is similar to shooting.
Only by accurately finding the bullseye can the target be more accurately hit
.
Therefore, refined clinical staging is particularly important for the treatment of FL
.
The previous FL staging was mainly based on morphology, immunohistochemical analysis, etc.
, and the boundaries were blurred
.
Later, the emergence of genetic analysis, molecular typing and other methods promoted the refined staging of FL
.
The current clinical practice should consider organically combining the four dimensions of morphology, genetics, immunology, and molecular biology, comprehensively and comprehensively assess the patient's condition under a refined framework, and implement fixed-point "breakthroughs" for effective treatment
.
Precision therapy requires not only a clear and precise stratification strategy, but also the support of related drugs
.
The fine stratification strategy avoids the "one-size-fits-all" approach to a certain extent.
With the support of this strategy, otuzumab can better serve the clinic, such as the treatment of relapsed and refractory FL patients for which there is no unified clinical treatment plan.
.
The clinical goal is to continuously bring better survival benefits to patients.
Under the current background of precision treatment, workers in the field of FL should make concerted efforts to continuously explore how to better apply otuzumab to FL clinical practice
.
Yimaitong: Ortuzumab was approved for the treatment of FL in China.
What changes will this bring to the treatment landscape of FL? Please share your views? Prof.
Liu Lin has been on the market in China for more than 20 years.
It is undeniable that many FL patients have benefited from this
.
The subsequent launch of a new anti-CD20 monoclonal antibody, ortuzumab, shows the potential to create a new pattern of FL treatment
.
Many studies have shown that the efficacy of ortuzumab combined with chemotherapy in the treatment of FL patients is significantly better than that of traditional rituximab combined with chemotherapy, and the quality of life of patients has also improved
.
It is gratifying that Ortuzumab has now entered China's National Medical Insurance Drug List, and many Chinese FL patients are expected to receive Ortuzumab treatment without having to look at the "O"
.
As octuzumab enters the medical insurance system, its application will be more extensive, and more patients will benefit from it
.
In order to achieve this goal, the state, society, relevant pharmaceutical companies, clinicians, etc.
should work together to actively promote the application of octuzumab in the real world.
The day when octuzumab is widely used may reshape the treatment landscape for FL.
time
.
Dr.
Liu Lin, Professor, Doctoral Supervisor, Chief Physician, Chief Physician, Chief Physician, Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, National Member, Hematology Branch, Chinese Medical Association Member, Hematologist Branch, Chinese Medical Doctor Association Member of the Hematopoietic Stem Cell Application Group of the Hematology Branch of the Chinese Medical Association Consultant of the Anti-Infection Group of the Hematology Branch of the Chinese Medical Association Member of the Lymphoma Alliance of the Chinese Anti-Cancer Association Member of the Standing Committee of the Hematology Professional Committee of the Chinese Medical Education Association Member of the Standing Committee of the Session of the Committee, Chairman of the Hematology and Oncology Committee of Chongqing Anti-Cancer Association, Vice Chairman of the Chongqing Hematology Committee Talents, famous teachers, won the National Natural Science Foundation of China, the key projects of Chongqing Municipal Science and Technology Commission and many other projects
.
He has published more than 70 papers at home and abroad, and is the deputy editor of 2 monographs by Prof.
Tang Xiaoqiong, MD, professor and master tutor, chief physician of the First Affiliated Hospital of Chongqing Medical University, member of the Hematology Rehabilitation Professional Committee of the Chinese Association of Rehabilitation Medicine, and Lymphoma of the Chongqing Anti-Cancer Association.
Member of the Standing Committee of the Committee Member of the Midwest Immune Deficiency Related Lymphoma Diagnosis and Treatment Collaborative Group of the China Anti-Lymphoma Alliance Member and Secretary of the Chongqing Chronic Lymphocytic Leukemia Working Group Member and Secretary of the Precision Medicine and Molecular Diagnosis Committee of the Chongqing Association of Integrative Medicine Committee member The member of the Professional Committee of Oncology and Cardiology of Chongqing Anti-Cancer Association has been engaged in the medical treatment, teaching and scientific research of hematological diseases for a long time.
Hematopoietic stem cell transplantation and oncology cardiology, funded by many projects, published dozens of academic papers in domestic and foreign core journals Scan the QR code below to enter the "Mystery Exploration" channel "Channel!
