Professor Huang Huiqiang talks about FL treatment: Otuzumab-a new weapon for first-line treatment, which can effectively improve patient outcomes

Among the many types of lymphoma, FL is one of the most common subtypes of indolent lymphoma, which is more common in middle-aged and elderly people
.

The median age of Chinese FL patients is 53 years old, which is younger than Western FL patients (60-65 years old)
.

With the acceleration of China's aging process, FL has shown a gradual growth trend
.

At present, FL cannot be completely cured, and it will recur after the disease is completely relieved, and the course of recurrence will continue to shorten, and the toxicity caused by multi-line therapy will gradually increase, which will bring a great disease burden to patients
.

However, traditional treatment schemes cannot meet actual clinical needs, and innovative drugs or innovative treatment schemes are urgently needed to improve the life cycle of patients and improve their survival benefits
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 The humanized glycosylated new anti-CD20 monoclonal antibody otuzumab has shown excellent efficacy in a number of studies related to indolent lymphoma, and was approved in China in June this year to be combined with chemotherapy for initial treatment The induction treatment and maintenance treatment of adult FL patients provide a new first-line treatment option for FL patients in China
.

 Yimaitong invited Professor Huang Huiqiang from Sun Yat-sen University Cancer Center to share with you the diagnosis and treatment process and clinical experience of Otuzumab
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Case profile: A 63-year-old male with stage III FL, FILIP2 score of 2 (medium risk), and good physical fitness
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It is hoped that an initial treatment plan with good efficacy and safety can be adopted to prolong long-term survival, reduce recurrence, and obtain a higher quality of life
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The patient is currently undergoing induction therapy with otuzumab combined with CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone)
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Case discussion and program selection Most FL patients face the risk of recurrence after the disease has resolved, while the survival time of patients who experience repeated recurrences is greatly reduced
.

Every year, about 2-3% of FL is transformed into other more aggressive types of lymphoma, such as diffuse large B-cell lymphoma (DLBCL), Burkitt’s lymphoma (BL), etc.
, making treatment more difficult
.

Because FL has a long course and is difficult to cure, improving the high-quality tumor-free survival of patients is the top priority
.

 For patients with advanced FL at stage III to IV who have treatment indications, there are currently many treatment options available, such as chemotherapy, immunotherapy (single or combination therapy), participation in clinical trials, and local radiotherapy
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The overall principle is to select the treatment plan individually according to the patient's age, physical status, comorbidities and treatment goals [1]
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Because the patient is in good physical condition and can tolerate chemotherapy treatment, immunochemotherapy should be the first choice for treatment of this patient
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On the premise of ensuring the efficacy and safety of medication, patients should achieve deeper remission, prolong progression-free survival (PFS) as much as possible, and reduce early progression (POD24) events to achieve prolonged overall survival (OS) and improve quality of life Purpose
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According to the "White Paper on Survival Status of Chinese Follicular Lymphoma Patients in 2020"[2], most FL patients continue to pay attention to new drugs/therapeutics, and up to 88.
56% of patients look forward to the launch of Otuzumab, which ranks among all expectations The first place for drugs
.

In 2011, the global phase III clinical trial GALLIUM study was officially launched.
Two years later, Chinese patients began to enroll.
Compared with the standard treatment regimen in the control group, the combination of otuzumab and chemotherapy can significantly reduce the risk of progression/recurrence or death34 %, PFS is significantly prolonged; the cumulative incidence of POD24 events has dropped significantly, and the risk of early progress is reduced by 46% [3]
.

 The Chinese subgroup analysis of the GALLIUM study showed that with a median follow-up of 71.
9 months, the disease progression rate in the G-chemotherapy group was lower (32% vs 51.
5%), and the 5-year PFS rate in the G-chemotherapy group was higher than that in the R-chemotherapy group (estimated 5 years) PFS: 66.
87% vs 53.
25%), and the cumulative incidence of POD24 events is lower (16.
0% vs.
21.
2%)
.

Figure Chinese subgroup PFS At present, otuzumab has been included in the recommendation of multiple authoritative guidelines around the world, including NCCN guidelines, China CSCO lymphoma guidelines and CACA lymphoma guidelines, and has become a new standard for FL treatment
.

Based on the excellent efficacy and safety benefits demonstrated by the GALLIUM study, after comprehensive clinical evaluation and patient needs, the preferred choice is Otuzumab combined with CHOP, which has more obvious advantages of PFS and POD24, for induction therapy and Otuzumab.
Anti-maintenance therapy to further extend the patient’s PFS
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Experts’ message: “Although the new incidence of lymphoma and the trend of younger ones are not optimistic, there is no need to worry too much
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The development of the lymphoma discipline has been continuously advancing, focusing on the needs of patients, and exerting innovation
.

There are quite a few targeted innovations.
The research results of the drug have verified the tangible benefits of patients with indolent lymphoma, including FL
.

Rituximab was approved in China 20 years ago, rewriting the history of lymphoma treatment in China
.

Diagnosis and treatment of lymphoma in China With the obvious improvement, the efficacy and survival of patients have also been continuously improved, but there are still many patients still eager for more effective treatment options
.

Now the application of otuzumab has brought new treatment options for FL patients in China , To help realize patients' desire to reduce the risk of recurrence and death and obtain a better quality of life
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 In terms of drug use, the performance of otuzumab is also very exciting
.

Otuzumab is administered by intravenous infusion, each infusion of 1000 mg, the time is about 3-4 hours [5]
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The GAZELLE study (NCT03817853) [6,7] announced at this year’s EHA and ASCO meetings proved that it is safe for FL patients to be given otuzumab for 90 min short-term infusion from C2, and it was not observed in C2 3 Grade 3 infusion reaction (IRR), only 1 case of Grade 3 IRR was reported in subsequent cycles
.

The study suggests that the 90-minute short-term infusion of otuzumab is expected to improve convenience and infusion efficiency, and further improve the quality of life of FL patients
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It is believed that based on years of rich experience in the application of rituximab, with the continuous increase of otuzumab medication experience, and the continuous improvement of the safety management level of otuzumab, Chinese doctors can change otuzumab.
It can be applied to FL patients to achieve the goal of good medicinal use and improving the quality of life of patients
.

"Professor Huang Huiqiang, Chief Physician, Professor, and Doctoral Supervisor, Deputy Director of the Department of Internal Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University Cancer Hospital Chief Expert of Lymphoma, Chairman of the Lymphoma Professional Committee of the Chinese Elderly Health Care Association, CSCO China Anti-Lymph Alliance Vice Chairman, CSCO Thyroid Cancer Committee Chairman of the Association, Vice Chairman of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association Committee references: 1.
Huang Huiqiang.
Guidelines for the diagnosis and treatment of follicular lymphoma in China (2020 edition).
Chinese Journal of Hematology, July 2020, Volume 41, Issue 7 2.
"2020 Chinese Follicular Lymphoma Patients Survival Status White Paper 3.
Robert Marcus, et al.
Obinutuzumab for the First-Line Treatment of Follicular Lymphoma.
N Engl J Med 2017; 377:1331-1344.
4.
ASCO 2020 conference abstract number: 8023.
5.
Otuzumab injection Manual.
6.
2021 ASCO conference abstract number: 7545.
7.
2021 EHA conference abstract number: EP807.
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