Dr. Kahl on Selecting Between PI3K Inhibitors in Follicular Lymphoma

Brad S. Kahl, MD, medical oncologist, Siteman Cancer Center, professor of medicine, Division of Oncology, Washington University School of Medicine in St. Louis, discusses selecting between PI3K inhibitors in follicular lymphoma.

Selecting between PI3K inhibitors is challenging because the differences in the available agents are relatively small, says Kahl. Patients whose insurance makes oral therapies cost prohibitive should be considered for intravenous treatment with copanlisib (Aliqopa) to limit out-of-pocket costs, Kahl explains. Additionally, patients who are noncompliant in taking oral medications could receive copanlisib, Kahl adds.

Regarding oral therapies, idelalisib (Zydelig) and duvelisib (Copiktra) have been established regimens in follicular lymphoma for years, so providers are comfortable using them, says Kahl. Conversely, umbralisib (Ukoniq) was FDA approved in February 2021, so providers could be unfamiliar with the agent and managing its associated toxicities, Kahl says.

Notably, umbralisib appears to be associated with a more favorable safety profile compared with idelalisib and duvelisib, so it could become the preferred oral PI3K inhibitor in follicular lymphoma, Kahl explains. However, real-world data are needed to confirm whether the safety profile with umbralisib is improved vs the other agents, concludes Kahl.