Dr Brem on the Potential Shift Away From Chemotherapy in Follicular Lymphoma

“[Looking at the] big picture, we are entering an era in follicular lymphoma [with] bispecific antibodies, CAR T-cell therapies, and many of us have been using lenalidomide-based therapies for years. I think there’s a good chance that in the next few years, we’re not really going to be using chemotherapy for follicular lymphoma.”

Elizabeth A. Brem, MD, associate clinical professor, medicine, University of California Irvine, highlights prospective treatment paradigm changes in patients with follicular lymphoma following safety lead-in data from the phase 3 OLYMPIA-1 trial (NCT06091254), noting the potential to move away from chemotherapy for this patient population.

Data from the safety lead-in portion (part 1) of the OLYMPIA-1 trial evaluating the CD20 and CD3 bispecific antibody odronextamab as monotherapy in patients with previously untreated grade 1 to 3 follicular lymphoma demonstrated that outpatient administration of the agent was deemed feasible. In the randomized portion of the study, patients are being randomly assigned to receive odronextamab or rituximab (Rituxan) plus investigator’s choice of chemotherapy backbone.

Although odronextamab is not currently FDA-approved for patients with follicular lymphoma, adding newer treatments, such as bispecific antibodies and CAR T-cell therapies, can help improve the follicular lymphoma treatment paradigm, Brem begins.

In part 1 of the OLYMPIA-1 trial, no dose-limiting toxicities (DLTs) or immune effector cell-associated neurotoxicity syndrome (ICANS) were observed (n = 13). Of note, all instances of cytokine release syndrome (CRS) were grade 1, and 100% of DLT-evaluable patients achieved complete remission at week 12 assessment. No grade 4/5 infections were reported; however, grade 3 infections occurred in 2 patients.

Any-grade treatment-emergent adverse effects (TEAEs) occurred in all patients; grade 3 or greater TEAEs were observed in 46.2% of patients, and serious TEAEs were reported in 38.5%. The most common TEAES included CRS (61.5%), diarrhea (46.2%), and rash (38.5%). One patient discontinued treatment due to elevated levels of liver enzymes, which emerged from treatment.

Brem notes that ongoing studies, including OLYMPIA-1, have shown that these newer therapies engage the immune system well—especially in early lines of treatment. In the next few years, the use of chemotherapy in follicular lymphoma could decrease as newer therapies continue to demonstrate improved efficacy, she concludes.