Professor Ma Jun: Standard treatment helps clinical standardization, and takes stock of the key points of the 2022 CSCO follicular lymphoma guidelines update

Based on evidence-based medicine, coordinating the availability of diagnosis and treatment products, and absorbing the latest medical progress, the annual update of the Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines has been widely praised and paid attention to by clinical clinics
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The recent epidemic is fierce, but with the joint efforts of experts, the 2022 edition of the CSCO Lymphoma Diagnosis and Treatment Guidelines has finally arrived as scheduled
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Follicular lymphoma (FL) is a common type of non-Hodgkin lymphoma (NHL).
The Chinese FL population accounts for 6.
28% of the NHL population, and the incidence is increasing year by year
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As an indolent lymphoma, FL has the characteristics of repeated relapse and progression, and most FL patients eventually require treatment, among which the survival rate of patients with early progression and relapse (POD24) decreases; FL increases with the number of relapses, the probability of transformation/refractory also increased
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Therefore, FL is a type of lymphoma that has attracted much clinical attention, and relevant practitioners have actively explored its diagnosis and treatment standards
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On the occasion of the release of the 2022 version of the CSCO Lymphoma Diagnosis and Treatment Guidelines, Yimaitong sincerely invites Professor Ma Jun from the Harbin Institute of Hematology and Oncology to interpret the updated highlights in the field of FL in the guidelines, and combine clinical practice to share the importance of standard treatment for FL treatment.

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Yi Mai Tong: Since the first edition was released in 2018, the CSCO guidelines have been updated every year, which has aroused strong clinical responses in China
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The principles of the guideline update have been attracting attention.
Could you please share what are the characteristics of the guideline revision principles in 2022? During the special period of the new crown epidemic of Professor Ma Jun, relevant practitioners in various places may not be able to have face-to-face contact due to the impact of prevention and control, but they cannot prevent the collision of ideas and academics
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During this period, the CSCO working group overcame all difficulties and united all parties to facilitate the 2022 guideline update to arrive as scheduled, handing in a new version of the "answer sheet" for relevant workers in the domestic oncology field
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The main process of this guideline is to initiate planning, investigate clinical issues, retrieve and evaluate evidence, formulate recommendations, write and publish
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In the preparatory process, the CSCO working group fully integrated the core authoritative research at home and abroad, strictly based on the evidence of evidence-based medicine, and updated the standards, methods and drugs of various types of tumor-related diagnosis and treatment in detail; Based on the actual situation of large clinical centers and primary medical institutions, the medical insurance policy and the availability of medical products are taken into consideration
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It is expected that the 2022 version of the CSCO guidelines will help further improve the level of clinical tumor diagnosis and treatment in China
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Yi Mai Tong: FL is a relatively common hematological tumor with high heterogeneity in clinical practice, and its clinical treatment plan has attracted much attention
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Could you please summarize the updated points about FL in the 2022 version of the CSCO lymphoma guidelines? Professor Ma Jun In recent years, the diagnosis and treatment of lymphoma have made rapid progress.
The lymphoma section has many updates, such as new target detection for pathological diagnosis, new drugs for treatment plan or adjustment of recommendation level,
etc.

FL field updates mainly include pathological diagnosis and first-line treatment options
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In terms of pathological diagnosis, MYC is recommended for level I for immunohistochemical testing, and MYC rearrangement and STAT6 mutation detection are recommended for level II of genetic and genetic testing.
The main reason for the introduction of this standard is related to diffuse large B-cell lymphoma.
(DLBCL) for differential diagnosis
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In terms of treatment options, the basic principles of first-line treatment of FL with anti-CD20 monoclonal antibody combined with chemotherapy have not changed.
Rituximab combined with chemotherapy is still the commonly used clinical treatment mode and the level of recommendation in the guidelines has not changed.
It is worth noting that the level I recommendation Newly added octuzumab + CHOP, octuzumab + CVP, octuzumab + bendamustine; in first-line maintenance or consolidation therapy, the new octuzumab single drug is recommended for class
I.

This guideline update establishes the regimen of otuzumab combined with chemotherapy followed by single-agent maintenance therapy as the new standard of first-line treatment
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The above updates are mainly based on the recent progress in diagnosis and treatment at home and abroad and the popularization of medical insurance policies, and further clarify and improve the diagnosis and treatment standards of FL in China
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Yi Mai Tong: Changes in clinical treatment methods are often based on a large amount of evidence-based medical evidence.
Could you please share what medical evidence is mainly based on the changes in treatment methods in this FL guideline update? What is your comment on this? Professor Ma Jun's CSCO working group mainly referred to the domestic and foreign clinical research progress in the field of FL in the process of formulating treatment standards
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In the field of untreated FL, a global multicenter, randomized controlled phase III GALLIUM study mainly compared otuzumab combined with chemotherapy (G-chemotherapy group) and rituximab combined with chemotherapy (R-chemotherapy group) ) efficacy of induction therapy for naïve FL patients, the results showed that the G-chemotherapy group improved progression-free survival (PFS) (3-year PFS rate of 80.
0% vs 73.
3%, HR=0.
66, P=0.
001), reduced the risk of disease progression [ 34% lower risk of progression/relapse or death; 46% lower risk of early progression (POD24)] and improved survival; in the field of relapsed and refractory FL, a global multicenter, open-label, randomized controlled phase III The GADOLIN clinical study mainly compared the effects of bendamustine monotherapy (group B) and octuzumab combined with bendamustine (group GB) in patients with FL who were relapsed and refractory to rituximab, respectively.
The results showed that the median PFS and median OS of the GB group were longer than those of the B group
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In addition, there are many clinical trials at home and abroad to explore the treatment of FL
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Based on a large amount of evidence-based medical evidence, the CSCO Lymphoma Guidelines Expert Group established the regimen of ottuzumab combined with chemotherapy followed by single-agent maintenance therapy as the new standard of first-line treatment in the 2022 edition of the Lymphoma Guidelines
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It can be seen that this change in treatment standard is not achieved overnight, but requires the support of evidence-based medical evidence.
This is the case in the process of any new drug being approved and included in the guideline recommendation.

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Yi Mai Tong: Standard treatment is an important concept in the field of tumor treatment.
Could you please share your understanding and experience of standard treatment for FL? Professor Ma Jun's clinical establishment of the concept of standard treatment is of great significance for promoting standardized clinical treatment
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In the field of FL, long-term clinical exploration has been carried out on the use standards of various drugs or regimens such as chemotherapy, original rituximab, otuzumab, bendamustine,
etc.

Since the launch of rituximab, based on a large number of clinical practices and real-world studies, the drug combined with chemotherapy has clinically established the treatment status of the drug in the field of FL, and this regimen has improved the survival of many FL patients
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Tumor treatment is a process of continuous development and progress, and the launch of octuzumab has further promoted the development of FL treatment on this basis
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At present, the authoritative guidelines at home and abroad recommend otuzumab ozogamicin combined with chemotherapy as the new standard of first-line treatment of FL
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Comprehensive clinical studies, guidelines, etc.
have established a standard treatment regimen: based on the pharmacokinetic (PK) characteristics, the single dose of octuzumab is optimized to 1000 mg
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After the first cycle of induction therapy was administered on days 1, 8, and 15, 6 or 8 cycles of induction therapy were performed depending on the combination regimen, followed by otuzumab monotherapy every two months.
Maintenance treatment for a total of two years
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The establishment of standard treatment programs is the guarantee for the standardized application of drugs, and the popularization of medical insurance policies is the "booster" of drug availability
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In 2021, as many as 18 anti-tumor drugs will enter China's medical insurance catalog, among which otuzumab, bendamustine and other lymphoma drugs are listed
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It was only half a year after the launch of Ortuzumab that it entered the medical insurance, benefiting many patients.
It is worth noting that the maintenance treatment of Ortuzumab is also covered by the medical insurance, filling the gap of the anti-CD20 mAb follicular maintenance treatment in the medical insurance catalog.
, not only can reduce the economic burden of patients, but also can greatly improve the compliance of patients with maintenance therapy, which is expected to further improve the survival of FL patients
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In general, the standard treatment plan provides guidance for the clinical drug use of cancer in China, and contributes to the construction of the overall clinical standardization
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Not only the field of FL, but also other lymphoma fields should be actively explored, and the concept of standard treatment should be popularized in the treatment of various tumor types to further improve the survival of tumor patients in China
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Yi Mai Tong: Could you please talk about the inspiration this guideline update brings to the clinical treatment of cancer in my country? What future efforts are needed to further improve the survival of FL patients? The update of Professor Ma Jun's guidelines is the result of the joint efforts of many relevant industry workers.
It is important that we learn from experience and lay the foundation for providing better standards of diagnosis and treatment
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The research and development of new drugs is the basis for the continuous advancement of tumor drug treatment.
Although many traditional drugs have benefited many patients, the clinical needs have gradually changed with the development of the times, and patients' needs for new drugs have increased
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Evidence-based medicine is the cornerstone of the formulation of clinical diagnosis and treatment standards, and the determination of diagnosis and treatment standards requires the tempering of various authoritative core studies
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The release and update of authoritative diagnosis and treatment guidelines establishes the overall framework of cancer treatment in China.
The CSCO guidelines are updated every year, providing a template for the field of clinical cancer in China
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In addition, strengthening the treatment standards and medical insurance policies of primary hospitals are important factors to promote the improvement of tumor treatment conditions
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After many efforts, the survival of lymphoma patients has been significantly improved, but relevant practitioners from all walks of life should not stop there.
In the future, the research and development of innovative drugs, especially targeted drugs should be further promoted; the existing treatment models should be optimized, and different drugs should be explored.
The combination application mode between different targeted drugs, the combination of targeted drugs and small molecule drugs, etc.
; further promote the popularization of medical insurance policies and ensure that more patients have drugs available
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I believe that the ultimate goal of clinical cure can be achieved at that time, and the world's cancer patients will be happy
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Summary The update of the CSCO guidelines for FL and other tumors is not only a change in the written text, but also a "strengthening shot" injected into the clinical tumor community in China.
The epidemic may be able to isolate you and me, but it cannot stop it.
The pure heart of practitioners from all walks of life - working hard to benefit more cancer patients
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The road is long and long.
We look forward to the multi-dimensional cooperation between hospitals, related pharmaceutical companies, and the government to make concerted efforts.
Based on the guidelines, with the goal of benefiting patients, we will continue to seek benefits for cancer patients, and jointly achieve the grand goal of "Healthy China 2030".
work hard
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Professor Ma Jun Director of Harbin Institute of Hematology and Oncology Chairman of the Supervisory Board of the Chinese Society of Clinical Oncology (CSCO) Vice Chairman of the Asian Society of Clinical Oncology Vice Chairman of the Chinese Society of Clinical Oncology Leukemia Expert Committee Chairman of the National Health Commission Capacity Building and Continuing Education Center Lymphoma The leader of the expert group of the construction project, the honorary consultant of the nursing group of the Lymphoma Expert Committee of the Chinese Society of Clinical Oncology, went to the Faculty of Medicine of the University of Tokyo, Japan to study in 1979
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In 1982, the in vitro multipotent hematopoietic progenitor cell culture system was first established in China, filling the domestic gap
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Since 1983, the sequential therapy of retinoic acid and arsenic trioxide has been used to treat more than 1,200 cases of acute promyelocytic leukemia.
The 10-year disease-free survival rate is 85%, reaching the international advanced level
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He has published more than 200 papers and more than 40 monographs in domestic and foreign journals, and won 20 national, provincial and municipal science and technology awards
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Undertook 8 national 863 major scientific research projects and 25 provincial and municipal scientific research projects
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Edit: Valamor Typesetting: Wenting Execution: Wenting pokes "read the original text", we progress together