CCO experts talk about I field perspective, cutting-edge style, Professor Zhang Qingyuan shares the latest progress in lymphoma treatment

In recent years, the development of new drugs, the rise of the combination drug model, and the popularization of medical insurance policies have greatly promoted the progress in the field of lymphoma.
The overall condition of lymphoma patients in China has improved.
Timely summarizing experience will help further promote the level of lymphoma diagnosis and treatment in China
.

The 2021 China Conference on Oncology (CCO) was successfully held from April 14th to 17th, 2022.
On this occasion, Imaitong specially invited Professor Zhang Qingyuan of Harbin Medical University Cancer Hospital to base on the current status of lymphoma diagnosis and treatment and combine the recent new developments in the field of lymphoma.
event to share the latest advances in lymphoma diagnosis and treatment
.

Yimaitong: This CCO has made a wonderful sharing on lymphoma.
Could you please talk about the current status of treatment in the field of lymphoma? What unmet clinical needs do patients have? As a whole, Professor Zhang Qingyuan shows that the treatment in the field of lymphoma presents a scene of "a hundred flowers blooming"
.

The emergence of a variety of new drugs such as octuzumab, BTK inhibitors, chimeric antigen receptor T-cell (CAR-T) therapy, etc.
, as well as the emergence of drug modes, has greatly enriched the treatment options in the field of lymphoma
.

In addition, the popularization of China's medical insurance policy has also played a key role in the treatment of lymphoma.
Commonly used drugs such as otuzumab and bendamustine have been included in the medical insurance, making drugs available to more patients and improving their living conditions
.

However, patients with lymphoma still have great clinical needs to be met
.

The treatment of patients with relapsed and refractory follicular lymphoma (FL), chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is still a difficult clinical problem, and the standard of diagnosis and treatment and drug selection need to be improved.
Multiple clinical investigations
.

Yimaitong: As a common type of lymphoma, FL has attracted much attention because of its high heterogeneity.
Could you please talk about the current clinical treatment progress in the field of FL based on clinical practice and related research? Prof.
Zhang Qingyuan’s previous research found that after first-line induction with rituximab combined with chemotherapy + 2-year maintenance of standard treatment for FL patients, 49% of the patients relapsed/progressed/died within 10 years, and 20%-25% of the patients were at the beginning of treatment.
Relapse or progression within 2 years (POD24), the clinical treatment needs of FL patients need to be met urgently
.

The clinic has actively explored this problem
.

In treatment-naïve FL patients, octuzumab plus chemotherapy significantly prolonged progression-free survival (PFS) (34% reduction in 3-year risk of recurrence and progression) and reduced POD24 risk (46% reduction) compared with rituximab plus chemotherapy ); in patients with rituximab relapsed and refractory FL, octuzumab combined with bendamustine significantly improved PFS and overall survival (OS) compared with bendamustine monotherapy ; Octuzumab + bendamustine + veneclax as the first-line treatment for high tumor burden FL, has shown beneficial efficacy and is expected to bring patients with a better treatment plan
.

In addition, our center has explored the use of otuzumab in the treatment of FL
.

One of the patients with naïve FL was treated with a cycle of octuzumab combined with bendamustine, and the symptoms basically disappeared, and a greater degree of remission was achieved after two cycles; there was another patient with relapsed and refractory FL.
The burden is high, and the treatment process is also tortuous.
After rituximab combined with chemotherapy, radiotherapy, octuzumab combined with chemotherapy, octuzumab combined with lenalidomide and other regimens, a complete remission (CR) was finally achieved.

.

In general, the combination of octuzumab and chemotherapy has been approved by several authoritative guidelines and has become the new standard for first-line FL treatment
.

Yi Mai Tong: The concept of combination therapy has gradually emerged in recent years, and the field of FL has established a new standard for first-line treatment with otuzumab combined with chemotherapy
.

In addition to FL, what are the treatment advances in other B-cell lymphoma fields? Professor Zhang Qingyuan's combination therapy has also been applied in other lymphoma fields such as CLL, SLL, and MCL
.

The concluded 2021 American Society of Hematology (ASH) updated the results of the CLL14 study: the combination of octuzumab and veneclax had a significant benefit in PFS compared with octuzumab and chlorambucil (74.
0% vs.
35.
4%, P<0.
0001), and TP53 deletion or mutation and IGHV unmutated subgroups also benefited
.

The results of a phase Ib/II, single-arm, open-label study showed that octuzumab combined with a BTK inhibitor had an objective response rate (ORR) of 100% in patients with newly diagnosed CLL; the results of the IcICLLe study showed that octuzumab Anti-combination BTK inhibitor therapy in patients with relapsed and refractory CLL can significantly and continuously enhance the depletion of CLL cells in peripheral blood and bone marrow
.

The latest study shows that the combination of zanubrutinib, octuzumab and veneclax can be used for the treatment of untreated MCL with TP53 mutation, with a CR of 64% and an ORR of 86%
.

Based on a large amount of evidence-based medical evidence, the National Comprehensive Cancer Network (NCCN) guidelines have recommended otuzumab-based regimens for treatment-naïve and relapsed and refractory CLL/SLL patients
.

In addition, the latest 2021 edition of China's lymphoma treatment guidelines has also included octuzumab in the first-line treatment recommendation for CLL/SLL, and octuzumab is expected to become the cornerstone of the treatment in the field of B-cell lymphoma
.

Yimaitong: Could you please talk about the inspiration that these advances have brought to my country's clinical practice? What is the future direction of lymphoma diagnosis and treatment? Professor Zhang Qingyuan's clinical progress cannot be achieved without the accumulation of a large amount of evidence-based medicine.
The above-mentioned FL, CLL, SLL and other lymphoma treatment methods may only be slightly changed in the guidelines, but behind the subtle changes are many clinical researchers.
With joint efforts, it is the reliable, effective and sufficient clinical trials that have laid the foundation for the treatment of lymphoma
.

In addition, medical insurance policy support is a “booster” for drugs to benefit patients.
Ortuzumab has been included in medical insurance after only half a year after it was launched in China, benefiting many FL patients, becoming a model for the availability of new drugs, and also providing other drugs.
valuable experience
.

In the future, the direction of lymphoma diagnosis and treatment should be diversified.
The research and development of new targeted drugs and the combined application model of multiple drugs are all directions worth exploring.
Further popularization of medical insurance policies can also promote the development of lymphoma diagnosis and treatment, so that patients can be treated if they are ill.
A drug-available target
.

Conclusion At present, the morbidity and mortality of lymphoma in China are still at a high level.
Standardized treatment and the provision of innovative drugs are the main methods to improve the prognosis of these patients
.

As the world's first humanized glycosylation-modified type II anti-CD20 monoclonal antibody, octuzumab has shown great potential in the field of B-cell lymphoma treatment, and is used for more and more tumors such as FL, CLL, SLL, and MCL.
Patients offer hope
.

Looking forward to the future, relevant practitioners from all walks of life will work together, actively explore, and benefit more patients
.

Expert Profile Professor Zhang Qingyuan Chief Physician, Second-level Professor, Doctoral Supervisor Director of Heilongjiang Cancer Institute Vice President of Harbin Medical University Affiliated Cancer Hospital Director-designate of Lymphoma Professional Committee of China Anti-Cancer Association Deputy Chairman of the National Key Specialty of Oncology Leader of the National Hundred Thousand Talents Project Selected by National Young and Middle-aged Experts with Outstanding Contribution Review: Evelyn Typesetting: XY Execution: Uni‍‍