Dr Amengual on Tazemetostat, Lenalidomide, and Rituximab in Relapsed/Refractory FL

Jennifer Effie Amengual, MD, Herbert Irving Assistant Professor of Medicine, Division of Hematology and Oncology, Center for Lymphoid Malignancies and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, discusses considerations for community oncologists looking to refer patients with relapsed/refractory follicular lymphoma (FL) to the ongoing second-line, phase 3 SYMPHONY-1 trial (NCT04224493).

The 3-stage SYMPHONY-1 trial is investigating the combination of tazemetostat (Tazverik), lenalidomide (Revlimid), and rituximab (Rituxan) in patients with relapsed/refractory FL. Stage 1 was a phase 1b safety run-in portion in which all patients received the triplet to determine the recommended phase 3 dose (RP3D) of tazemetostat. Stage 2 is a phase 3 portion that will randomly assign patients to receive lenalidomide and rituximab plus either tazemetostat at the RP3D of 800 mg twice daily, or placebo. Stage 3 is an optional portion in which patients will receive tazemetostat at the RP3D plus rituximab and lenalidomide in 28-day cycles.

Tazemetostat is an effective treatment option for patients with FL who can delay more intensive regimens, Amengual says. Since both tazemetostat and lenalidomide are oral agents, this triplet regimen can also be administered as a mostly outpatient treatment, Amengual notes. In SYMPHONY-1, patients receive intravenous rituximab for the first 5, 28-day cycles before receiving an entirely oral regimen, so they only need to visit the clinic for a few months at the start of treatment, Amengual explains.

So far, most patients enrolled in SYMPHONY-1 who were refractory to rituximab in their previous line of therapy have responded to tazemetostat plus lenalidomide and rituximab, Amengual emphasizes. Additionally, all patients who relapsed within 24 months of their first line of therapy, who are classified as having POD24 and comprise approximately one-third of the phase 1 patient population, have responded to the triplet, according to Amengual. This tolerable, easy-to-administer regimen may overcome common barriers to treatment experienced by patients with rituximab-resistant, rituximab-refractory, or POD24 disease, Amengual concludes.