Published: 20th February 2024
Living with follicular lymphoma (FL) means navigating through various treatment options, and in recent years, the landscape of FL treatment has been reshaped by new types of immunotherapy. This innovative approach has shown significant potential in transforming the way we approach treatment. The ability to utilise the body’s own immune system has emerged as a game-changer in lymphoma therapy.
What is Immunotherapy?
Immunotherapy is a type of cancer treatment that harnesses the body’s immune system to fight cancer. It leverages substances produced naturally by the body or synthesised in laboratories to boost the immune system’s ability to recognise and attack cancer cells. There are various types of immunotherapies, but for FL we are most excited about the use of T-cell engagers.
Traditionally, cancer treatment heavily relied on chemotherapy until the introduction of rituximab in 1997, a pivotal moment that altered cancer treatment. Since then, immunotherapy has progressively transformed FL management, initially making strides in aggressive lymphomas before extending its reach to FL over the past five years. This shift signifies a move towards a smarter, more targeted approach in combating FL.
Key immunotherapy approaches
CAR-T cells and bi-specific antibodies stand out as two forefront immunotherapy strategies garnering significant attention. These therapies target specific cell-surface proteins present on B cells, such as CD19 and CD20, commonly found in FL. The exciting news is that both CAR-T cells and bi-specifics have been approved to treat patients with multiply relapsed FL in some countries, marking a significant milestone in the field of cancer treatment.
Data presented at the American Society of Hematology (ASH) Annual Meeting in December 2023 confirmed the high response rates and prolonged efficacy of these immunotherapy approaches. Studies with longer monitoring of patients who participated in clinical trials, as well as “real-world” studies of patients treated outside of trials, have demonstrated very high response rates that last for several years or longer in many patients.
The role of bi-specific antibodies
Despite the success of CAR-T treatments, unfortunately, some people do not respond well, and challenges such as varying responses, side effects, and accessibility persist. Bi-specific antibodies effectively bring T-cells and B-cells together, enhancing cell targeting without the need for modifying T-cells individually. Because they are “off-the-shelf” products rather than individualised, they offer a promising alternative to CAR-T. There are pros and cons to CAR-T and bi-specifics, and it is encouraging to have both moving forward. Bi-specifics in particular are moving quickly into the earlier treatments with several trials active or planned.
Early integration of immunotherapy
A promising frontier in FL research involves exploring the integration of immunotherapy treatments earlier in a patient’s journey, including as initial therapy. This approach holds the potential to minimise the need for chemotherapy or even pave the way for a chemotherapy-free treatment strategy. By integrating immunotherapy into the early stages of FL treatment, we aim to further improve patient outcomes and enhance the long-term management of the disease. Many questions remain regarding the earlier use of immunotherapy, requiring clinical trials to answer. The FLF is supporting such trials.
FLF research into immunotherapy
Immunotherapy is poised to play a pivotal role in shaping the future of FL management. The ongoing efforts to enhance these treatments, increase response rates, and extend the duration of response reflect a collective commitment to advancing the standard of care for FL patients.
As well as the research into earlier integration of immunotherapy mentioned above, the FLF is actively involved in supporting research programmes aimed at improving immunotherapy for FL. The CURE FL Awards are dedicated to funding research in this field. These awards support innovative research projects that seek to enhance the effectiveness of immunotherapy and develop new treatment approaches for FL. Read more about the CURE FL Awards Cycle 1 and the research focused on improving immunotherapies in FL.
Acknowledgements: Thank you to our Scientific Advisor, Prof. Jessica Okosun and to Dr. Will Lavelle and Dr. Carina Edmondson for their ASH 2023 insights.
Disclaimer: This article serves to inform patients about the potential of immunotherapy in treating follicular lymphoma. Patients are
advised to consult with their healthcare providers for personalised treatment recommendations and considerations.
