Up until now, our paradigm—particularly in indolent lymphoma—has been episodic treatment, remission, and retreatment at emergence of symptoms. Very frequently, we can show that you can defer therapy in asymptomatic patients until relapse,” explained Andrew D. Zelenetz, MD, PhD, Vice Chair of the Department of Medicine and former Chief of the Lymphoma Service at Memorial Sloan Kettering Cancer Center, New York, and Director and Chair of the NCCN Congress on Hematologic Malignancies.
“The concept that we can treat continuously until disease progression represents a paradigm shift that comes with newer drugs that are approved as continuous therapy in chronic lymphocytic leukemia, such as ibrutinib and idelalisib,” he continued.
Jennifer R. Brown, MD, PhD, Director of the Chronic Lymphocytic Leukemia Center at Dana-Farber Cancer Institute, Boston, weighed in on the discussion. “One issue related to use of targeted therapy is that if a patient on continuous therapy becomes resistant, then we wouldn’t be able to reuse that therapy later when symptoms emerge. We want to gain the longest durable benefit for our patients. It is an open question whether this is achieved by continuous therapy or breaks in therapy with treatment at disease progression,” she stated. ■
Disclosure: Drs. Zelenetz and Brown reported no potential conflicts of interest.
The use of targeted therapies in indolent non-Hodgkin lymphoma (NHL) is a burgeoning area. New targeted therapies directed at the cell surface, intracellular pathways, and the microenvironment are being studied for relapsed indolent NHL. These treatments, if validated in large randomized trials,...