Lenalidomide and R-CHOP in follicular lymphoma: where do we go from here?

In The Lancet Haematology, Hervé Tilly and colleagues 1 Tilly H Morschhauser F Casasnovas O et al. Lenalidomide in combination with R-CHOP (R2-CHOP) as first-line treatment of patients with high tumour burden follicular lymphoma: a single-arm, open-label, phase 2 study. Lancet Haematol. 2018; 5: e403-e410 Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar present data from a phase 2 trial of 80 patients treated at 16 centres in France using rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone with the addition of lenalidomide (R2-CHOP) in patients with follicular lymphoma with high tumour burden (assessed by Groupe d'Etude des Lymphomes Folliculaires criteria). The anticipated primary endpoint, a target complete response of 80%, was not met. However, this combination led to an overall response in 75 (94%) of 80 patients, with a complete response in 59 (74%) of 80 patients. The 3-year progression free survival was 79%, and 3-year overall survival was 95%. At 30 months from registration, 55 (69%) patients achieved a complete response. Toxicity was not insignificant, but while grade 4 neutropenia developed in 52 (65%) patients, febrile neutropenia only occurred in six (7%) patients. How do these data affect our thinking about follicular lymphoma? Is this combination treatment a new standard of care? Is the chemotherapy a necessary component? To answer these questions, we should first understand two key issues closely related to this trial: what are the current treatment options for patients with high tumour burden follicular lymphoma; and what is lenalidomide, how does it work, and why should we be using it in follicular lymphoma? Lenalidomide in combination with R-CHOP (R2-CHOP) as first-line treatment of patients with high tumour burden follicular lymphoma: a single-arm, open-label, phase 2 studyImmunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is a standard front-line treatment for follicular lymphoma. The combination of lenalidomide and rituximab has shown high efficacy in relapsed or refractory and untreated follicular lymphoma. We aimed to evaluate the safety and activity of the combination of lenalidomide and R-CHOP (R2-CHOP) in previously untreated patients with high burden follicular lymphoma. Full-Text PDF