EHA 2024: Golcadomide Alone or Combined with Rituximab in Relapsed/Refractory Follicular Lymphoma

Here, we summarize a new study presented at the European Hematology Association (EHA) congress by Dr. Julio Chavez from the Moffitt Cancer Center. He discusses the treatment with a new agent called golcadomide (also known as golca, by BMS) in combination with rituximab for patients with follicular lymphoma who progressed or lost response to previous therapies (relapsed and refractory).

What Is Golcadomide?

Golcadomide is part of a new generation of drugs that are classified as cereblon E3 ligase modulators or CELMoDs. It is a type of medication that targets the protein cereblon, which has a role in adjusting the immune response to cancer. 

Similarly to immunomodulators (IMiDs), CELMoDs are also oral medications but are considered to have improved efficacy and tolerability, making them a promising option for patients who can't tolerate IMiDs like lenalidomide or whose lymphoma become refractory. 

Previous studies have shown an effective safety profile and also indicate that the mechanisms of action of golcadomide can be more effective when combined with the standard of care, rituximab-based therapy. 

Commonly Reported Side Effects with Golcadomide

The side effects reported so far with golcadomide are not new to lymphoma physicians; however, for some patients, it meant they had to reduce or discontinue their treatment with golcadomide. The most common side effects are:

• Decrease in blood cell counts in more than 50% of patients: low white blood cells (neutropenia), low platelets (thrombocytopenia), and low red blood cells (anemia).
• Infections
• Fever

HealthTree had the opportunity to interview Dr. Julio Chavez, who summarized for us the latest data he presented about golcadomide in follicular lymphoma. 

Key takeaways

This is an ongoing Phase 1/2 clinical trial recruiting patients with relapsed/refractory follicular lymphoma who had been treated with at least 2 prior therapies. You can find all the information about this trial and the hospitals that are still recruiting participants here (NCT03930953). 

• Golcadomide is an oral medication that was given for 14 days followed by 14 days off schedule, alone or combined with intravenous rituximab. 
• The initial data reported is in 48 patients. 
  • Of note, some patients had been treated with CAR T-cell therapy before entering this study.
• Over 70% of patients responded to the treatment with golcadomide, although higher response rates and, particularly, complete response rates were reported with the combination with rituximab. 
• So far, the responses seem to be durable.
• As described in previous studies, the most common side effect was neutropenia (experienced by more than half of the patients). 
• Other side effects than altered blood cell counts were fatigue, diarrhea, and rash.

In summary, golcadomide induces deep and sustained remissions in patients with follicular lymphoma who had already been treated with most of the available treatments and can potentially be more efficacious when combined with rituximab. This study is ongoing and recruiting more participants to confirm these findings. 

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Sources:

• Safety and Efficacy of Golcadomide, a Potential First-in-Class Celmod Agent ± Rituximab in a Phase 1/2 Open-Label Study of Patients with Relapsed/Refractory (R/R) Follicular Lymphoma (FL)