Understanding Your Treatment Options After Being Diagnosed with Advanced-Stage Follicular Lymphoma

If you are a person with advanced-stage follicular lymphoma who is starting their first treatment, learn how certain therapy options compare. 

Choosing Your First Treatment with Advanced-Stage Follicular Lymphoma 

The European Society for Medical Oncology (ESMO) guidelines recommend that advanced-stage follicular lymphoma patients receive chemotherapy in combination with a monoclonal antibody: obinutuzumab (Gazyva, Genentech) or rituximab (Rituxan, Genentech). 

The question is: which chemotherapy regimen and which monoclonal antibody do you choose? 

Please note that non-advanced stages of follicular lymphoma have different treatment recommendations. In some cases, these patients may not be treated and are simply observed. Click here to learn more. 

R-CHOP vs. R-B for Follicular Lymphoma 

Advanced-stage follicular lymphoma patients receiving treatment for the first time will usually have either R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) or R-B (rituximab and bendamustine). After the initial chemotherapy cycles are completed, patients will usually receive rituximab infusions over the next two years as a maintenance therapy. 

In a clinical trial called the GELTAMO study, researchers evaluated if R-CHOP or R-B were more effective for advanced-stage follicular lymphoma patients. 

Six years after patients started treatment, their findings showed: 

• 79% of patients treated with R-B were still in remission 

• 67% of patients treated with R-CHOP were still in remission

Rituximab vs. Obinutuzumab for Follicular Lymphoma 

Monoclonal antibodies like rituximab and obinutuzumab treat follicular lymphoma by targeting a protein called CD20 on the surface of cancerous B cells. This marks the cancer cells for destruction by the immune system.

Does the monoclonal antibody you choose as part of your chemotherapy regimen matter? 

The GALLIUM study found that follicular lymphoma patients treated for the first time had improved outcomes when they included obinutuzumab, rather than rituximab, in their chemotherapy regimens, followed by only the antibody as a two-year maintenance therapy. 

After 7.9 years since the start of treatment: 

• 63.4% of patients treated with obinutuzumab-based regimens remained in remission

• 55.7% of patients treated with rituximab-based regimens remained in remission 

Patients on rituximab also needed to start their next cancer treatment sooner than those on obinutuzumab. 

However, both monoclonal antibody groups showed no difference in overall survival, which measures the time patients lived after starting treatment. 

Summary 

Patients with advanced-stage follicular lymphoma who are beginning their first treatment have important choices to make, including selecting a chemotherapy regimen and a monoclonal antibody to accompany it.  

The research shared here indicates that the R-B regimen, which combines rituximab and bendumustine, results in better long-term remission rates compared to R-CHOP. 

Additionally, a study comparing the monoclonal antibodies obinutuzumab and rituximab for follicular lymphoma patients found that obinutuzumab outperforms rituximab when used in chemotherapy regimens followed by maintenance treatment with the antibody.  

It is important to discuss treatment options with your doctor to ensure that you are receiving the best therapy for your personal situation. 

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Follicular Lymphoma Newsletter

Sources: 

• Newly Diagnosed and Relapsed Follicular Lymphoma: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up

• Comparing R-Bendamustine vs. R-CHOP Plus Maintenance Therapy as First-Line Systemic Treatment in Follicular Lymphoma: A Multicenter Retrospective GELTAMO Study

• Obinutuzumab Versus Rituximab Immunochemotherapy in Previously Untreated iNHL: Final Results From the GALLIUM Study