Role of bortezomib in the treatment of follicular lymphoma

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Published: 13 Feb 2011
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Prof Bertrand Coiffier - Hospices Civils de Lyon, France
The addition of bortezomib to rituximab therapy for patients with relapsed or refractory, rituximab-naive or rituximab-sensitive follicular lymphoma was shown to improve progression-free survival, response rate and time to next antilymphoma treatment. Prof Bertrand Coiffier discusses this trial, and explains the results of a second trial which compared two different bortezomib schedules in follicular lymphoma patients who had suffered multiple relapses. Patients in this study showed a greater response when bortezomib was administered at 1.5 mg/m² twice weekly than when it was delivered as a weekly dose of 1.6mg/m2.

 

 

Speaker key

 

 

IV         Interviewer

BC        Bertrand Coiffier

 

 

IV         What was this study all about?

 

BC        It’s a study in relapsing patients with follicular lymphoma so that the reason we picked...  There were two arms, one with Rituximab alone and the other with Rituximab plus Bortezomib.  And that was the reason we picked on laser patients that were naive for Rituximab, or sensitive to Rituximab, because if they were refractory it would not be a good thing to randomise them to Rituximab alone.

 

IV         So you're already going to get an effect from the Rituximab so you are trying to see if Bortezomib adds...?

 

BC        Yes.

 

IV         What happened?

 

BC        So it was a large trial, probably one of the largest trials in relapsing follicular lymphoma with more than 600 patients, and this is a final analysis and we show that the combination, Bortezomib plus Rituximab, has a superior progression survival than Rituximab alone. 

 

IV         And I want to ask you about another study and I’m going to ask you some clinical implications for these, but you've also got a phase II study looking at two different schedules of Bortezomib, and that’s in recurrent or refractory follicular lymphoma.  What was that all about?

 

BC        It was a different study.  Here it was a phase II study not for first relapse follicular lymphoma patients, but patients that had many relapses.  And in this study it was a phase II randomised study where we test two modalities of Bortezomib alone, and what we find first is that Bortezomib alone as efficacy in follicular lymphoma in relapse, whatever the number of pre chemotherapies they have received, and secondly, that Bortezomib two times a week is slightly superior to Bortezomib once a week with a higher dose.

 

IV         What are the practical implications for treatment in therapy coming out of these two studies then?

 

BC        What is important here first is that it proves that Bortezomib has activity in follicular lymphoma.  Secondarily, what is important for patients with follicular lymphoma is the fact that they may receive a lot of regimens because, you know, it’s an incurable disease so they respond but relapse, respond and relapse, and so you need to have a lot of possible treatments for these patients.  And so one of these possible treatments that has efficacy and a low toxicity is Bortezomib.

 

IV         And even though you're getting a response with the Rituximab you can still add Bortezomib yourself?

 

BC        Yes, and you still have Bortezomib plus Rituximab.

 

IV         So what would you say now to cancer doctors?  What’s coming out of this, what’s the take-home message?

 

BC        The take-home message is that the survival of patients with follicular lymphoma is very long currently because we have increased the number of possible therapeutics and each patient may receive a lot of different regimens before becoming refractory to anything.  And one of these regimens is Bortezomib alone or Bortezomib plus Rituximab.  And, with that, you have progression survival that is long, around one year, so you may use it without toxicity at some times.

 

IV         You said without toxicity.  There were some toxicities though.

 

BC        No, it was mild toxicity, lighter than chemotherapy.

 

IV         So on the whole you're being quite reassuring, are you?

 

BC        Yes.

 

IV         Yes?

 

BC        No, what I say is the median survival of patients with follicular lymphoma is increased because we have now a lot of different therapeutics and each regimen has a response of around ten to 12 months.  So if you use 20 regimens, that’s 20 years of survival.