From the Guidelines
Follicular lymphoma should be treated with rituximab-based immunochemotherapy regimens as the standard of care for first-line therapy, as it has been shown to improve outcomes in patients with this condition. According to the study published in the Journal of the National Comprehensive Cancer Network in 2014 1, follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin's lymphoma, accounting for approximately 22% of all newly diagnosed cases of non-Hodgkin's lymphoma. The incorporation of rituximab to chemotherapy regimens has become a widely accepted standard of care for first-line therapy for patients with FL.
Some key points to consider in the management of follicular lymphoma include:
- The disease is generally considered chronic, characterized by multiple recurrences with current therapies
- Maintenance and consolidation therapy with rituximab and radioimmunotherapy have been associated with improved progression-free survival in patients experiencing response to first-line therapy, as noted in the study 1
- Treatment depends on the stage and symptoms, with some early-stage patients requiring only watchful waiting
- Standard options for those needing treatment include rituximab-based immunochemotherapy regimens, typically administered in 6-8 cycles
- Localized disease may be treated with radiation therapy alone, while advanced or relapsed disease might require different combinations or targeted therapies.
Overall, the goal of treatment is to improve outcomes and quality of life for patients with follicular lymphoma, as the disease is generally incurable but highly treatable, with many patients living for decades with good quality of life through sequential treatments as needed, as supported by the evidence from the study 1.
From the FDA Drug Label
1. 1 Non–Hodgkin's Lymphoma (NHL)RITUXAN is indicated for the treatment of adult patients with: Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent Previously untreated follicular, CD20-positive, B-cell NHL in combination with first line chemotherapy and, in patients achieving a complete or partial response to a rituximab product in combination with chemotherapy, as single-agent maintenance therapy Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL as a single agent after first-line cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy.
Rituximab is indicated for the treatment of follicular lymphoma in adult patients. The possible treatment regimens include:
- Relapsed or refractory follicular lymphoma as a single agent
- Previously untreated follicular lymphoma in combination with first-line chemotherapy, and as single-agent maintenance therapy in patients who achieve a complete or partial response
- Non-progressing follicular lymphoma as a single agent after first-line CVP chemotherapy 2
From the Research
Follicular Lymphoma Overview
- Follicular lymphoma (FL) is a type of cancer that affects the immune system, specifically the lymphatic system.
- It is characterized by the abnormal growth of lymphocytes, a type of white blood cell, in the lymph nodes and other parts of the body.
Treatment Strategies
- Various treatment strategies are available for FL, including watchful waiting, chemotherapy, radiation therapy, and immunotherapy 3, 4.
- Watchful waiting is often recommended for patients with low-tumor burden FL, while chemotherapy and radiation therapy are typically used for patients with more advanced disease 3, 4.
- Immunotherapy, such as rituximab, has also been shown to be effective in treating FL, particularly in combination with chemotherapy 5, 6, 7.
Outcomes and Toxicities
- Studies have compared the outcomes and toxicities of different treatment strategies for FL, including R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and R-B (rituximab and bendamustine) 6, 7.
- R-B has been shown to have similar overall response rates and complete remission rates compared to R-CHOP, with fewer toxicities 6.
- Maintenance therapy with rituximab has also been shown to improve outcomes in patients with FL, particularly when used after R-B therapy 7.
Quality of Life
- Quality of life (QoL) is an important consideration in the treatment of FL, particularly for patients with advanced disease 5.
- Studies have shown that rituximab can improve QoL in patients with FL, particularly when used in combination with chemotherapy 5.
- Watchful waiting has also been shown to have a negative impact on QoL in patients with FL, particularly in terms of emotional well-being and feelings of control over their disease 5.