Big coffee explores "Auspiciousness" | Professor Xu Wei and Professor Cen Hong: From the status quo to progress, talk about the new direction of diagnosis and treatment of follicular lymphoma

Follicular lymphoma (FL) is the most common indolent non-Hodgkin lympho.
For most patients, anti-CD20 combined with chemotherapy is the standard treatment for .
In recent years, new drugs and new methods have emerged one after another, and the diagnosis and treatment strategies for FL are constantly being introduc.
Therefore, Yimaitong specially invited Professor Xu Wei from the First Affiliated Hospital of Nanjing Medical University and Professor Cen Hong from the Cancer Hospital Affiliated to Guangxi Medical University to discuss the frontier progress and new directions of diagnosis and treatment of FL based on the current situation of diagnosis and treatme.
Yimaitong: In recent decades, the continuous advent of new drugs has improved the survival of .
Please discuss the unmet needs of patients in light of the current status of diagnosis and treatment of .
Professor Xu Wei In recent years, the treatment of FL has been significantly improv.
With the widespread application of rituximab, the progression-free survival (PFS) of patients has been significantly prolong.
The efficacy of the new generation anti-CD20 monoclonal antibody octuzumab is more prominent than that of the type I anti-CD20 monoclonal antibody rituximab, providing a better treatment option for FL patien.
The global phase III randomized controlled GALLIUM study was followed up for 3 years The results showed that the PFS rate in the octuzumab-chemotherapy group was 80%, which was significantly higher than that in the rituximab-chemotherapy group (80% vs 73%; HR 66; P=00
Although there has been great progress in prognostic evaluation models, all prognostic models have no guiding significance for the selection of treatment optio.
In addition, among the current risk stratification models for FL, some models are no longer applicable in the era of new drugs, and some models in The required parameters cannot be developed in normal clinical practi.
Therefore, more accurate prognostic models that are suitable for the new drug era and can guide the selection of clinical regimens still need to be further explor.
The unmet needs of patients can be summarized into the following three aspects: first, it is currently impossible to identify very high-risk patients with POD24 that progresses within two years after treatment, and how to predict FL patients with poor prognosis is still a problem; third Second, about 30%-40% of patients with FL may undergo disease transformation during the disease process, that is, to diffuse large B-cell lympho.
How to detect these patients in advance through effective means; third, domestic clinical More effective treatments are needed for relapsed/refractory (R/R) .
With the improvement of Professor Cen Hong's understanding of the disease and the launch of a variety of new targeted drugs, the treatment mode of FL has gradually developed to a targeted, "chemo-free" regimen; the prognostic model is also based on the common clinical indicators prognostic model FL Internation.
The prognostic index (FLIPI), FLIPI-2, e.
turned to molecular models m7-FLIPI, POD24-PI,e.
About 20% of FL patients develop POD24 after first-line chemoimmunotherapy, and POD24 tends to cause poor survival outcomes and shorten surviv.
However, various prognostic tools currently have certain limitations and cannot identify POD24 patients as early as possib.
Therefore, while developing more accurate prognostic tools, there is a greater need to apply POD24 risk-reducing drugs in first-line therapy, reducing disease recurrence and early progressi.
Yimaitong: In clinical work, how do patients with newly diagnosed FL choose a treatment plan? In clinical practice, Professor Cen Hong needs to determine the stratified treatment strategy according to the grading and staging of FL, GELF tumor burden, and treatment indicatio.
For stage I-II FL patients, radiotherapy alone is the main treatment recommendation, but effective biomarkers need to be found to identify patients with high recurrence risk ear.
About 70% of patients have reached advanced disease (stage III or IV) at the time of diagnos.
For stage III-IV FL patients with indications for treatment, after evaluating the patient's underlying disease and tolerance, anti-CD20 monoclonal antibody combined with chemotherapy is often select.
Program
With the new anti-CD20 monoclonal antibody octuzumab entering the clinic, its efficacy in the field of FL has been verified in multiple clinical tria.
The study found that compared with the traditional rituximab plus chemotherapy regimen, the combination of octuzumab and chemotherapy reduced the risk of progression, recurrence and death in FL patients by 34%, and the relative risk of POD24 events decreased by 46% , and there was no significant difference in safety between the two schem.
At present, octuzumab has been recommended by a number of domestic and foreign authoritative guidelines including NCCN and CSCO, setting a new standard for first-line treatment of .
In the recently updated 2022 version of the CSCO lymphoma diagnosis and treatment guidelines, octuzumab combined with chemotherapy for first-line induction and octuzumab single-agent maintenance therapy have been included in the class I treatment recommendati.
2022 edition of CSCO Lymphoma Diagnosis and Treatment Guidelines Pr.
Xu Wei's accurate diagnosis and staging of lymphoma are crucial to the selection of appropriate treatment metho.
Clinically, the treatment plan can be selected according to the PET-CT results and the patient's physical sta.

First-line treatment of FL is also evolving with the addition of maintenance therapy, bendamustine (Benda), octuzumab (G), and lenalidomide (Len), as well as numerous new dru.

A recent meta-analysis compared the efficacy of 11 commonly used FL treatment regimens in seven phase 3 randomized controlled clinical trials (Studies: FOLL05, PRIMA, StiLNHL1, BRIGHT, StiLNHL7, GALLIUM, and RELEVANCE studies; protocol: R -CVP, R-CHOP, R-Benda, R-CVP-R, R-CHOP-R, B-Benda-R, R-Benda-R4, G-CVP-G, G-CHOP-G, G-Benda -G and R-Len-.
Except for the R-Benda-R4 regimen, which is a 4-year maintenance treatment with R, if there is maintenance treatment in the other regimens, it will continue for 2 yea.

The results of the analysis showed that, based on the R-Benda regimen, the G-Benda-G regimen resulted in the best PFS (HR=41, 95% BCI 26–76), followed by the R-Benda-R4 regimen (HR=41, 95% BCI 26–7
49, 95% BCI 29–05) and the R-Benda-R regimen (HR=60 95% BCI 44–8
This suggests that octuzumab as a first-line combination drug has a stronger ability to control disease progression and recurrence than rituxim.

In evaluating the likelihood of optimal treatment (PbBT), G-benda-G was more likely than R-Benda-R4 and R-Benda-R (72% vs 25% vs 3.

Yi Mai Tong: At present, octuzumab has entered the medical insurance, and more patients can benefit from octuzum.

Please share your valuable experience in the application of octuzum.

Professor Xu Wei Ortuzumab has been included in the National Medical Insurance Catalogue, and now clinically naïve FL patients who meet the treatment indications usually choose Ortuzumab combined with chemotherapy, because Ortuzumab is the first in the field of .

A targeted drug that achieves full coverage of induction and maintenance therapy, filling the gap in the protection of FL maintenance therapy in the catal.

The patients admitted to our department were evaluated for efficacy after 3 cycles of octuzumab treatme.

Now, some patients have entered the interim analys.

The efficacy is similar to the results reported in the GALLIUM study, and the effect is worthy of recogniti.

Medical insurance helps more patients receive new standard treatment regimens, and the first-line use of otuzumab is more conducive to improving the quality of life of patien.
Professor Cen Hong said that drug accessibility is the core of its application val.

Reducing the burden on patients and allowing good drugs to enter medical insurance are important measures to improve drug accessibili.

Ortuzumab, as the world's first type II humanized anti-CD20 monoclonal antibody that has undergone glycosylation, took just over 3 months from its launch at the end of August last year to its entry into the medical insurance li.

In the first-line treatment, the combination regimen of octuzumab was used for induction + octuzumab single-agent maintenance, and the patients' PFS was long.

At present, our department has accumulated a certain amount of experience in the application of ortuzum.

Its safety during infusion is good, and the adverse reactions are similar to those of rituximab, and no unexpected adverse events have occurr.

Yimaitong: What is your outlook on the development trend of FL treatment in the future? Professor Cen Hong's FL is a typical indolent lymphoma, and the patient's overall prognosis is go.

With the improvement of people's understanding of the genetics and immunobiology of FL, new drugs continue to emer.

FDA approv.

CAR-T cell therapy is a means that can help patients achieve long-term survival and even cu.

At the same time, we look forward to the application of safer and more effective targeted drugs and treatment regimens in the clinic, which will ultimately improve the prognosis of FL patients while avoiding overtreatme.

The emergence of many new drugs and new therapies by Professor Xu Wei is constantly changing the treatment strategy and treatment pattern of .
At present, related new drugs have appeared in terms of protein expression, abnormal signaling pathway, and tumor microenvironment of FL, including new anti-CD20 monoclonal antibodies, bispecific antibodies, trispecific antibodies and other drugs targeting protein expression; Small molecule targeted inhibitors such as EZH2 inhibitors, PI3K inhibitors, and BTK inhibitors; immune checkpoint inhibitors targeting the immune microenvironment, and CAR-T cell therapy,e.

For newly treated FL patients, the emergence of new drugs and new therapies is expected to reduce the risk of early disease progression after first-line treatment, prolong disease remission time and PFS, and improve overall survival (O.

Emergence promises to enrich the treatment strategy of combination regimens, improve quality of life, and prolong .
Professor Xu Wei, Chief Physician, Deputy Director of the Department of Hematology and Doctoral Supervisor of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital), Vice Chairman of the Hematology and Tumor Professional Committee of the China Anti-Cancer Association, and Head of the Lymphoma Group of the China Elderly Health Care Association Lymphoma Vice-chairman of the Professional Committee Vice-chairman of the Lymphoma Branch of the Chinese Medical Education Association Member of the Lymphoma Professional Committee of the Cancer Society Member of the Experimental Hematology Professional Committee of the Chinese Pathophysiology Association Member and Secretary of the Integrated Hematology Professional Committee of the Chinese Medical Doctor Association Integrative Medicine Physician Branch Vice President, Jiangsu Research Hospital Association Lymphoma Professional Committee Chairman, Jiangsu Anti-Lymphoma Alliance Chairman Chairman of the editorial board of "Chinese Journal of Hematology", "Chinese Journal of Experimental Hematology", "International Journal of Blood Transfusion and Hematology", "Leukemia·Lymphoma" and "BLOOD Chinese Version", e.

Pr.

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Cen Hong Affiliated to Guangxi Medical University Director of Lymphoma and Hematology Oncology Department of Cancer Hospital, Director of Teaching and Research Department of Medical Oncology Graduated from Hunan Medical University, .


of Hematopoietic Stem Cell Transplantation Center of Zhejiang University School of Medicine, Visiting Scholar of Duke University Medical Center, Chairman of Guangxi Anti-Cancer Association Lymphoma Professional Committee Chairman of Guangxi Anti-Cancer Deputy Chairman of the Association's Chemotherapy Professional Committee Standing Committee Member of the Guangxi Anti-Cancer Association Biological Therapy Professional Committee