Indolent lymphomas: advances from ASH 2012
Dr Mathias Rummel – Universitaetsklinik, Giessen, Germany
What is the current treatment strategy for indolent lymphoma?
At the moment now we still use chemotherapy in combination with rituximab and also in addition to that we consolidate with rituximab maintenance but these treatments absolutely needs to be improved and therefore we will listen to all this new information about the new agents in the treatment of these diseases.
What are the potential new agents?
Yes, we are waiting for the results of the new anti-CD20 antibody from Roche, the GA11 and not very mature results will be presented but we’ll learn a little bit about the toxicity profile and maybe get insights into some of the efficacy data. But the large randomised trials are not yet reported so we will have to wait for that. Beyond that there are some new agents, some small molecules like ibrutinib or GS-1101 and for that we have learned that they can be combined with existing chemotherapy plus rituximab where some dose finding studies report it and also some single agent activities were shown. With these agents we hope that we get some more compounds in the future which are very active in the treatment of these diseases.
Explain more about the adverse effects of these agents?
The report, for example, was ibrutinib that is in general a very well tolerated drug but we have to imagine that these drugs in the future have to be given every day continuously. So we of course can only see what happened in terms of toxicity with the duration of treatment so far, we need clearly longer and more experience. So far these new agents taken as a pill every day appear to have a very good tolerability.
You talked about CD20 as a target, what about other potential targets?
Yes, of course, there are some different antibodies developed and we know them already for some years but I have not seen any really major breakthroughs with these new antibodies and also the radio-immune conjugated antibodies are still under discussion but again we have not seen some very convincing results which urge us to use these radio-immune conjugates in the treatment. Also I have seen a trial taking interferon to rituximab because it was postulated that interferon might up-regulate the CD20 so this would be a better condition to treat with rituximab but the results were not so convincing, unfortunately.
Do these targeted agents improve quality of life?
Yes, all companies who are developing these new agents absolutely understand that they need to present also quality of life data, in particular when this treatment will be given continuously and this is more or less a chronic disease in which you cannot achieve a cure with these medications. I think it is very important also from the perspective from authorities to see what the quality of life is in these circumstances. Interestingly, there was one trial presented with chemotherapy and rituximab. This was the so-called BRIGHT trial where they compared bendamustine-rituximab against standard of care, which was CHOP-rituximab or CVP-rituximab, and they also looked for the quality of life. That was a very interesting approach and I think this will be done now in the future in all of these large trials. Also in the PRIMA trial with maintenance it was reported and here we learned from the results from the BRIGHT study that the bendamustine-rituximab really improved the quality of life in nearly all parameters.