Managing 3rd-Line R/R FL: Recognizing Progression, Performing Rebiopsies, and Rechecking for CD20 Positivity

EP: 1.Overview of R/R FL: Focus on the 3rd-Line Setting and Beyond START

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EP: 2.Managing 3rd-Line R/R FL: Recognizing Progression, Performing Rebiopsies, and Rechecking for CD20 Positivity

EP: 3.Aligning Treatment Goals in R/R FL: Physician vs Patient Perspectives

EP: 4.Clinical Scenario: A 73-Year-Old Patient With R/R FL Requires Treatment in the Third-Line Setting

EP: 5.Expert Perspectives: Tazemetostat in R/R FL

EP: 6.Choosing Between Tazemetostat and Zanubrutinib+Obinutuzumab: Key Factors & Patient Conversations

EP: 7.Assessing CAR T and Bispecifics for R/R FL: Identifying the Right Candidates & Factoring in CD20 and CD19 Negativity or Positivity

EP: 8.Navigating Treatment Choices in R/R FL: Patient Values and Shared Decision-Making

EP: 9.Managing R/R FL: Evolving Sequencing Strategies

EP: 10.Key Strategies and Perspectives: How Novel 2nd-Line Therapy Options May Impact 3rd-Line Treatment Landscape in R/R FL and Bridging Strategies to CAR T

EP: 11.Collaborating With Community Providers in Treating Patients With Complex R/R FL

EP: 12.Looking Ahead in R/R FL: Unmet Needs and What’s Next

EP: 13.Physician Assistant Perspectives: Aligning Patient Goals in R/R FL and Navigating Third-Line Treatment Options

EP: 14.Physician Assistant Perspectives: Importance of Patient Shared Decision-Making and Multidisciplinary Team Approach in R/R FL

EP: 15.Physician Assistant Perspectives: When to Consider Tazemetostat in R/R FL

Summary for Physicians:

Topic: Role of Rebiopsy and CD20 Reassessment in Suspected Progression of Follicular Lymphoma After Second-Line Therapy

Key Points:

1. Rebiopsy at Suspected Progression:

• Rebiopsy is generally recommended when progression is suspected after second-line therapy in relapsed/refractory follicular lymphoma (R/R FL).

• The purpose of rebiopsy is to confirm true progression, rule out a transformation to a more aggressive histology (eg, diffuse large B-cell lymphoma), and to reassess disease biology, which can change over time.

• Histologic transformation may require a different therapeutic approach, making tissue confirmation critical for guiding treatment decisions.

1. Reassessment of CD20 Expression:

• In addition to confirming progression or transformation, rechecking for CD20 positivity is an important part of the rebiopsy process.

• Loss of CD20 expression, although relatively uncommon, can occur following anti-CD20 monoclonal antibody therapy and may affect the efficacy of subsequent treatments.

• Knowing the CD20 status is essential, especially when considering further anti-CD20-based therapies, such as rituximab or obinutuzumab.

Clinical Implication: A rebiopsy at the time of suspected disease progression provides vital diagnostic and prognostic information, including the possibility of transformation and CD20 status. These data directly inform subsequent therapeutic decisions and can help tailor third-line or investigational treatments in patients with R/R FL.