Follicular Lymphoma: What Role Should PI3K Inhibitors Play in Treatment?

According to a video from OncLive, Dr. John P. Leonard from Weill Cornell Medicine discussed the role of PI3K inhibitors in the treatment of follicular lymphoma, a rare cancer. While this class of medicines could be useful in patients experiencing relapse, which is common, they are unlikely to be used as a first-line option. This is primarily due to the strong prevalence of adverse side effects. 

About Follicular Lymphoma

Follicular lymphoma is a type of blood cancer. While generally considered rare, it is the most common type of slow growing non-Hodgkin’s lymphoma. This cancer affects follicle center B-cells, which are also known as centrocytes. There appears to be a genetic basis for follicular lymphoma, and the cancer has been linked to translocation between chromsomes 14 and 18. This results in the overexpression of a gene called bcl-2. Symptoms for this cancer are similar to other blood cancers, such as night sweats, fever, infections, weight loss, swollen lymph nodes, shortness of breath, and fatigue. Treatment options may include monoclonal antibodies, chemotherapy, radioimmunotherapy, and stem cell transplant. Some patients can survive for decades with follicular lymphoma, with a median survival time of 10 years. The five year survival rate is 72 to 77 percent. With the newest treatments, survival rates are improving. To learn more about follicular lymphoma, click here.

Using PI3K Inhibitors

New PI3K inhibitors are in the process of being developed. Most of the ongoing trials that involve these therapies are also evaluating different dosing schedules with the goal of minimizing toxicity and side effects. Only continued study of these inhibitors will reveal if reduced toxicity can improve efficacy via fewer discontinuations of treatment. 

Ultimately, these therapies will be most utilized for relapsed/refractory cases. Dr. Leonard says that more research should focus on which treatment combinations are the most suited for these patients and on identifying the characteristics of patients that are most likely to benefit from PI3K inhibitors.

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