PI3K Inhibitors in R/R Follicular Lymphoma - Episode 5

Looking Ahead to the Future Treatment of FL

Pier Luigi Zinzani, MD, PhD:The take-home message on the basis of these 3 abstracts regarding copanlisib is that copanlisib is a very important and active single agent in the treatment of relapsed and refractory follicular lymphoma [FL] because at 2 years of follow-up, there are some patients who convert from PR [partial response] to CR [complete response], and there are several patients in continuance of response without any kind of long-term adverse effects. At the same time, it’s possible to treat—without any kind of problem in terms of toxicity and also in terms of clinical efficacy—patients with diabetes and hypertension. And, finally, I think it’s very important that the last message concerning…copanlisib as a single agent is that you can have a very good result also in high-risk patients, represented by the patients with a POD [progression of disease] of less than 24 months in terms of CR rate, overall response rate, and also median duration of response.

I think it’s sufficient to say the goal in the second step is to combine copanlisib with conventional chemotherapy. So the concept is to try to move from the right to the left for the relapsed/refractory patient or now to second line or…to try to increase the CR rate and the median progression-free survival for the patient in frontline. So the concept is to try to finalize, for example, CHOP [cyclophosphamide, doxorubicin, vincristine, and prednisone] plus rituximab plus copanlisib in frontline or bendamustine plus rituximab plus copanlisib in frontline. This could be the future. But we will complete this trial within the next 18 months, and potentially in the next 2, 3 years, we can have the final data to really understand…the role of copanlisib when we move the single agent to combination with conventional chemoimmunotherapy in second line or in frontline in the treatment of follicular lymphoma and also of other indolent lymphomas, like marginal zone lymphoma.

First of all, I think it’s very important to the concept to try to combine, in the future, conventional chemotherapy plus a new class of agent like…a PI3K inhibitor like, for example—in particular—copanlisib. The second could be the concept of CAR [chimeric antigen receptor] T-cell therapy also in the treatment of follicular lymphoma. There are several new bispecific monoclonal antibodies and also antibody drug conjugates. This could be the future for the vision for the next 5 years in the setting of follicular lymphoma.

Transcript edited for clarity.