Looking Ahead in R/R FL: Unmet Needs and What’s Next

EP: 1.Overview of R/R FL: Focus on the 3rd-Line Setting and Beyond START

EP: 2.Managing 3rd-Line R/R FL: Recognizing Progression, Performing Rebiopsies, and Rechecking for CD20 Positivity

EP: 3.Aligning Treatment Goals in R/R FL: Physician vs Patient Perspectives

EP: 4.Clinical Scenario: A 73-Year-Old Patient With R/R FL Requires Treatment in the Third-Line Setting

EP: 5.Expert Perspectives: Tazemetostat in R/R FL

EP: 6.Choosing Between Tazemetostat and Zanubrutinib+Obinutuzumab: Key Factors & Patient Conversations

EP: 7.Assessing CAR T and Bispecifics for R/R FL: Identifying the Right Candidates & Factoring in CD20 and CD19 Negativity or Positivity

EP: 8.Navigating Treatment Choices in R/R FL: Patient Values and Shared Decision-Making

EP: 9.Managing R/R FL: Evolving Sequencing Strategies

EP: 10.Key Strategies and Perspectives: How Novel 2nd-Line Therapy Options May Impact 3rd-Line Treatment Landscape in R/R FL and Bridging Strategies to CAR T

EP: 11.Collaborating With Community Providers in Treating Patients With Complex R/R FL

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EP: 12.Looking Ahead in R/R FL: Unmet Needs and What’s Next

Summary for Physicians:

Unmet Needs in R/R FL:

Despite progress in the treatment of R/R FL, several unmet needs remain:

1. Durability of Responses: While treatments such as CAR T therapies, bispecific antibodies, and EZH2 inhibitors show efficacy, achieving long-term remissions remains challenging for some patients. More treatments that provide durable responses are needed to extend the time between relapses.
2. Adverse Effect Management: Current therapies, such as cytokine release syndrome with CAR T or infusion-related reactions with bispecifics, present ongoing concerns. There is a need for therapies with fewer long-term toxicities and better adverse effect profiles, especially for older or frail patients.
3. Personalized Treatment: The development of biomarkers to guide therapy decisions is a major area of need. Identifying which patients will benefit most from specific treatments, such as EZH2 inhibitors or targeted agents, remains a challenge. A more personalized approach is necessary for optimal treatment selection.
4. Resistance to Therapy: Therapeutic resistance remains an issue, with patients developing resistance to therapies such as Bruton tyrosine kinase inhibitors and anti-CD20 treatments, leading to treatment failure. Overcoming resistance is critical to improving outcomes in R/R FL.
5. Access and Affordability: New treatments, particularly CAR T, may be inaccessible to some patients due to financial and logistical barriers. This issue is especially prominent in rural or underserved areas, where access to advanced therapies is limited.

Exciting Developments in R/R FL Treatment:

Several areas of advancement in the treatment of R/R FL hold promise for the future, including the following:

1. Emerging Targeted Therapies: The development of bispecific antibodies and novel immune therapies offers hope for patients who have not responded to traditional treatments. These therapies offer alternative mechanisms of action and may overcome resistance to existing therapies.
2. Improved CAR T Therapies: Ongoing advancements in CAR T technology, such as improvements in manufacturing and reducing adverse effects, are exciting. These developments could enhance the accessibility and effectiveness of CAR T, even for patients with high disease burdens.
3. Combination Approaches: Combining immunotherapies, targeted therapies, and chemotherapy may improve treatment outcomes in R/R FL. Such approaches could enhance response rates and progression-free survival by targeting multiple pathways at once.
4. Personalized Medicine: The increasing use of biomarkers to guide treatment decisions could lead to more personalized treatment plans. This approach would maximize efficacy while minimizing unnecessary adverse effects for patients.
5. Improved Access and Affordability: There is growing optimism that efforts to improve access to novel therapies—through better reimbursement strategies and making treatments available in rural areas—will help ensure that more patients benefit from cutting-edge treatments.

These advancements offer hope for more effective, long-lasting, and accessible treatments for R/R FL.