Physician Assistant Perspectives: Aligning Patient Goals in R/R FL and Navigating Third-Line Treatment Options
A panelist discusses how treatment decisions for relapsed/refractory follicular lymphoma (R/R FL) hinge on prior therapies, balancing goals between remission and disease control, while considering patient factors like age, access, and preferences among options such as CAR T-cell therapy, bispecific antibodies, and oral regimens.
When treating patients with follicular lymphoma in the relapsed setting, one of the main considerations is how many prior lines of treatment the patient has already undergone. The ultimate goal often differs between patients and providers. While many patients hope for remission or a cure, follicular lymphoma is generally not curable, so achieving remission or controlling disease progression becomes the primary objective. Especially in later lines of therapy, the focus may shift from aggressive attempts to eliminate disease to simply stabilizing it and preventing further progression, as some treatments may take longer to work or carry greater risks compared to earlier, more aggressive therapies.
In the third-line treatment setting, there are multiple options available, including CAR T-cell therapies, bispecific antibodies, and oral regimens like tazemetostat or zanubrutinib combined with obinutuzumab. The challenge lies in selecting the most appropriate therapy based on the individual patient's characteristics. Factors such as age, treatment accessibility, financial burden, and preferences about treatment duration are key considerations. Some patients prefer a defined course of treatment that is intense but limited in duration, while others may opt for ongoing oral therapy that offers convenience but requires long-term commitment and monitoring.
The decision-making process involves educating patients about the benefits and drawbacks of each option. CAR T-cell therapy, for example, often requires hospitalization and frequent clinic visits, with potential for significant toxicity. Bispecific antibodies also involve an initial period of frequent dosing before transitioning to less frequent visits. Oral therapies can be convenient but may pose financial challenges, especially for those on Medicare. By incorporating patients’ lifestyles and preferences into the conversation, providers can help tailor treatment plans that balance efficacy, safety, and quality of life in this complex setting.
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