Bruce D. Cheson, MD; Gilles Salles, MD, PhD


June 13, 2013

In This Article

Follicular Lymphoma: Curable or Chronic Disease?

Dr. Cheson: Absolutely. Should we change our goal in follicular lymphoma? We are going to eventually cure this disease. It will be a disease like diabetes or hypertension, where you just take a pill every day for the rest of your life and you feel fine, but you are not really disease-free. Should we change that and abandon the goal of a cure?

Dr. Salles: We should not abandon the goal of a cure. We have made so much progress in recent years with increasing complete remission rates and with new tools to monitor patients, such as MRT and PET/CT, that we improved the complete remission rate, we improved the molecular complete remission rate, and we improved progression-free survival and overall survival. So we should continue to aim for that. However, when patients relapse, maybe that is a goal -- the idea that we can maintain these patients for an extended period of time.

The point of the long-term treatment with this agent is that so far we haven't seen mutants or resistance, but I am convinced they will occur, and that given the biology of B cells that mutate many genes, we will very quickly see the emergence of mutant clones. So, that is an argument for a combination with chemotherapy or a combination with several drugs.

Dr. Cheson: Designing clinical trials with these drugs is a challenge, particularly in combination chemotherapy, because the response rates are so high. Your group has made one of the most important contributions to this field -- the 2 studies[4,5] on PET scans showing that PET scan negativity is potentially a surrogate endpoint. We are using that in our clinical trials now. That is the way to go, and it has been a really great contribution.

Dr. Salles: Thank you for mentioning this work. We looked retrospectively at the patients from the PRIMA study,[4] but also prospectively in another study[5] and identified that in patients receiving rituximab chemotherapy, having a negative PET/CT at the end of the induction was predictive of progression-free survival and overall survival. We need to bring that into our practice.


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