Dr. Kahl on Efficacy of Targeted Agents in Relapsed/Refractory Indolent Lymphomas

Brad Kahl, MD, professor of medicine, Division of Oncology, Siteman Cancer Center, Washington University School of Medicine in St. Louis, discusses the efficacy of targeted agents across indolent lymphomas.

Targeted therapies have varying levels of activity in follicular lymphoma and marginal zone lymphoma (MZL), says Kahl.

For example, PI3K inhibitors such as idelalisib (Zydelig), duvelisib (Copiktra), and copanlisib (Aliqopa), are approved for patients with relapsed/refractory follicular lymphoma, says Kahl. However, the agents do not have clear utility in MZL.

In 2017, ibrutinib (Imbruvica) received an accelerated approval from the FDA for the treatment of patients with relapsed/refractory MZL. The same dosing strategy utilized in MZL is used in mantle cell lymphoma (MCL). Additionally, the BTK inhibitor is associated with nearly a 50% response rate and median progression-free survival of around 14 months in patients with relapsed/refractory MZL.

While ibrutinib has activity in MZL, MCL, chronic lymphocytic leukemia, and small lymphocytic lymphoma, it has demonstrated limited efficacy in follicular lymphoma, says Kahl.

It is important to note that not all indolent lymphomas respond the same to targeted therapy when selecting treatment for patients, concludes Kahl.