The Future of Advanced Follicular Lymphoma Treatment

Timothy Fenske, MD, MS:Regarding practical advice for using obinutuzumab, I really don’t think it’s a whole lot different from rituximab. Oncologists in practice are very familiar with rituximab. They’ve been using it for years. There’s really nothing substantially different about giving obinutuzumab. There is a slightly higher rate of infusional reactions and cytopenias, and we do need to watch for infections. But the way we deal with those infusional reactions, the way we manage those cytopenias, is really the same as what we’ve been doing for years with rituximab.

I would say that whether it’s rituximab or obinutuzumab that you’re using with induction and with maintenance, bear in mind that patients who received bendamustine as part of their induction do have some risk for infections. Most of those infections are seen during the maintenance phase. You need to be vigilant in terms of watching these patients. If they have what looks like a pneumonia or some other symptoms of infection, they really must get worked up. Many of these patients have a significant lymphopenia. They may have low CD4 counts and low immunoglobulin levels, and these infections need to be identified and treated appropriately.

I think this is an exciting time to be treating lymphoma, in particular follicular lymphoma. This is a disease for which the expected survival has gone up substantially just in the last couple of decades. And we have recently identified an important endpoint of early progression of disease as having a big influence on how patients do with their lymphoma. Until recently we had very little within our control to potentially reduce that risk of early progression. I think this recent data from the GALLIUM study are exciting in that they show us that by just switching the antibody from rituximab to obinutuzumab, we can reduce the risk of early progression from 17% to 10%.

With the recent updated data from the GALLIUM study, we can see that simply by switching the anti-CD20 antibody from rituximab to obinutuzumab, we can reduce the rate of early progression from 17% to 10%. This is something we now have within our control: to reduce the risk of early progression for these patients with follicular lymphoma, which is a very important endpoint for them.

Transcript edited for clarity.