Dr Shouse on Currently Available Targeted Therapies for FL

Geoffrey Shouse, DO, PhD, assistant professor, Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, discusses currently available targeted therapies for the treatment of patients with follicular lymphoma (FL) and compares the utility of targeted therapies vs traditional chemotherapy.

Over the years, significant advancements have been made in the development of targeted therapies for FL, and several molecular targets have emerged as promising avenues for treatment, Shouse begins. One notable development in PI3K inhibitors was the introduction of copanlisib (Aliqopa) in FL, though, in November 2023, the drug was withdrawn from the market, he reports. In contrast, the BTK inhibitor zanubrutinib (Brukinsa) in combination with obinutuzumab (Gazyva) received accelerated FDA approval in March 2024 for the treatment of patients with relapsed/refractory FL.

Lenalidomide (Revlimid) was one of the first targeted therapies to gain FDA approval for FL, specifically in combination with rituximab (Rituxan), he continues. This combination can also be used in the frontline treatment setting. Another treatment option is tazemetostat (Tazverik), which has been approved for use in the third-line setting. However, ongoing research indicates that tazemetostat may hold promise when used in combination regimens earlier in the treatment process, Shouse explains.

The distinction between targeted therapies and traditional chemotherapy is significant, he continues. Traditional chemotherapy is designed to target rapidly dividing cells, which often results in the destruction of both cancerous and healthy cells, leading to substantial toxicity, according to Shouse. In contrast, targeted therapies are engineered to focus on specific pathways active within cancer cells, he says, noting that this approach allows for a more precise attack on the cancer and minimal damage to healthy cells, thereby reducing toxicity.

Additionally, many targeted therapies offer the advantage of oral administration, which is more convenient for patients compared with the intravenous administration of chemotherapy, Shouse adds. This ease of use, combined with potentially lower toxicity, makes targeted therapies a compelling option for treating patients with FL, he concludes.