Selecting Second-Line Therapy: Balancing Targets, Toxicities, and Durability
December 12th 2025
Segment III explores how clinicians approach second-line therapy in follicular lymphoma, particularly as new options challenge traditional standards. Dr. Mehta reviews how CD20-directed therapies have historically anchored relapse treatment but notes the shift toward more diverse targets, including CD3 (via bispecific antibodies) and CD19 (via tafasitamab and other emerging agents). This expansion raises important clinical questions around target sequencing, resistance, and whether using a target early may “burn” it for future lines of therapy.
The discussion highlights the role of bispecific antibodies, CAR T-cell therapy, and CD19-based agents, along with practical considerations such as infusion requirements, monitoring demands, and access to treatment centers with specialized capabilities. Dr. Mehta explains how academic-community partnerships influence real-world treatment pathways, especially for therapies with more complex toxicity profiles like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).
NP Bailey contributes perspective on patient logistics, including distance to treatment centers, social support needs, and how the complexity of treatment may shape patient decision-making. She emphasizes the importance of aligning therapy selection with patient lifestyle and functional status, a theme that recurs throughout the program.
This segment underscores the increasingly individualized nature of second-line therapy, where clinicians must integrate disease biology, treatment history, patient comorbidities, and practical feasibility. As the faculty outline, modern management requires balancing efficacy with safety, accessibility, and long-term planning, ensuring that patients receive not only effective but sustainable care.
