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Using Prior Response and Repeat Biopsy to Guide Sequencing Strategy in Follicular Lymphoma
Andrew Zelenetz, MD, PhD, discusses the dual strategy of using the duration of benefit metric and re-biopsy to navigate complex sequencing decisions in targeted lymphoma therapy.
EP: 1.The Clinical Utility of Updated Immunophenotyping Guidelines in Follicular Lymphoma
EP: 2.Challenges to NGS Testing for Follicular Lymphoma in the Community Setting
EP: 3.Data Supporting Tafasitamab, Lenalidomide, and Rituximab in Second-Line Follicular Lymphoma
EP: 4.Considering Third-Line Loncastuximab Tesirine Plus Rituximab in Follicular Lymphoma
EP: 5.Sequencing Anti-CD19 Therapies in Follicular Lymphoma
EP: 6.Patient Factors Influencing Follicular Lymphoma Treatment Sequencing
EP: 7.Updated Biosimilars Statement Anticipates Future Approvals
EP: 8.Using Prior Response and Repeat Biopsy to Guide Sequencing Strategy in Follicular Lymphoma
A central challenge in relapsed/refractory follicular lymphoma is determining a treatment sequence that maximizes current outcomes while intentionally preserving future therapeutic options. Since follicular lymphoma is highly heterogeneous, the most practical guidance for clinicians hinges on assessing the quality of the patient's prior response.
Clinicians should evaluate whether the prior treatment provided a duration of benefit that was less than or greater than the expected median duration of benefit. For example, if a second-line regimen like tafasitamab plus lenalidomide yielded a poor progression-free survival (PFS) of only 6 months vs an expected median of 22 months, this indicates aggressive disease that may require a dramatic change in approach, such as moving to CAR T-cell therapy. Conversely, a patient achieving a 4-year remission is considered to have a more favorable response, leaving more treatment options open.
An important practice is to re-biopsy at the time of relapse. In the current era of targeted immunotherapy, clinicians must know exactly what targets (like CD19, CD20, or others) are being expressed on the tumor. A repeat biopsy with comprehensive immunohistochemistry, flow cytometry, and next-generation sequencing will indicate antigen loss or the evolution of new mutations. This objective re-assessment of the tumor biology is an ideal piece of data to inform the optimal subsequent sequence of treatment.
