Highlights

In follicular lymphoma the median age of diagnosis is about mid-60s, 64, 65, something like that, and that’s different from CLL, which is 72, 73. The reason I bring that up is that […] when I see a patient with a median age of 64–65, in the US the median life expectancy is mid-80. So, all things being equal, I would like to have something that will give me 20 years of life, even if I cannot cure the patient. If I get response or PFS of 20 years, then that patient gets to their mid-80s and dies of natural history. […] In follicular lymphoma if you have a drug that is a third-line drug, you will get usage because if you do the math, and we can go through it later, the first two lines that we have in follicular lymphoma still leave you short about 7–8 years in that median patient I’ve talked about, in terms of getting them to their mid-80s.

In the first line there are several options, and it ranges from rituximab single-agent to rituximab plus chemotherapy. So, I call it the R plus X paradigm. X could be zero, which is R monotherapy, or X could be chemo, and we have different kinds of chemo, we have bendamustine-Rituxan or we have R-CHOP, whatever. So, what is missing is an R plus X where X is targeted therapy, that is better than R plus zero, but safer than R plus chemo. So, to go back, Rituxan single-agent, or Rituxan plus chemo, we’re looking for R plus something else that is not chemo, so that’s sort of an unmet need there.

I’m not a big believer in obinutuzumab, and this is a controversial point. Some of my colleagues do more, I don’t, I believe it’s more a Roche attempt to circumvent the patent issue of rituximab. So, obinu will have some incremental progression-free survival difference, 10 months was the difference that led to approval in a disease where you have a life expectancy of many, many years, and so that’s not much difference. The FDA approved it, but it has more side effects for sure, particularly in older people, if you give them obinutuzumab they actually have more infusion reactions and so forth.