Finding Common Ground: Considerations for Making Treatment Decisions in R/R Follicular Lymphoma

This article includes expert insight from Jennifer Garson, PA-C, a Physician Assistant at Rush University Medical Center in the department of hematology in Chicago, IL with almost 19 years of experience in cancer care. Information presented does not encompass all considerations for TAZVERIK® (tazemetostat) eligibility. Jennifer Garson, PA-C was compensated for her time by Ipsen.

Follicular lymphoma (FL) is the second most prevalent type of non-Hodgkin lymphoma (NHL), accounting for approximately 30% of all lymphoma cases.i An indolent, slower growing cancer, there is no cure for FL. However, it can be treated and for the majority of individuals who experience relapse or become refractory, there are many treatment options.

With many treatment options comes an important opportunity for patients to be involved in making decisions about their care long-term based on their lifestyle and treatment goals.

Entering a New Era of Options for R/R FL

In the past decade, the number of FDA-approved therapies for R/R FL across a variety of modalities have expanded considerably with at least 15 common regimens to consider across lines of therapy.ii These advancements have led to improvements in our understanding of the genetic, epigenetic, cellular and immunological aspects of FL.iii

“Historically, there really wasn’t a role for the patient to have a lot of input in their care because we didn’t have a lot of treatment options,” explains Garson. “Luckily, we are now in a paradigm with lots of different treatment options and modalities available to tailor a patient’s care to meet their specific needs and goals throughout the course of disease.”

"Being able to incorporate a patient’s goals of care and lifestyle considerations into the conversation is something that has evolved in the last decade with the emergence of more treatment options.”

For Garson, that means open conversations from the onset. “It’s important to understand what their lifestyle looks like and how treatment will fit into it.”

Fostering Two-Way Dialogues

The treatment paradigm shift has resulted in the growing importance of the patient voice and role it plays in supporting a healthcare provider’s understanding of the unique needs and goals for treatment. Garson notes that in her practice, this is particularly meaningful for individuals who are in the second or third-line setting and may have a greater understanding of their disease and what they want from a treatment standpoint.

In Garson’s experience, a patient’s goals and expectations are not always aligned with their care team. In some instances, providers may also consider potential implications of common co-morbidities in patients with follicular lymphoma.

“From a provider standpoint, treatment goals aren’t always the same. That’s why it’s important to find a middle ground through open conversations about expectations and goals for treatment.”

According to Garson, this is true across the care team model—whether it’s doctors, nurse navigators, social workers, pharmacists, cardio-oncologists or anyone; everyone plays a crucial role across the care continuum to ensure the patient’s views are the top priority. As Garson likes to put it, “this is their journey, not mine. I’m here to be a tour guide on this road.”

Finding the Right Fit, at the Right Time

The basis for determining treatment in FL is guided by its indolent nature. Since it is a very heterogeneous disease, the treatment pathway isn’t always straightforward with many patients requiring multiple lines of treatment.iv

For Garson, treatment considerations around safety, response to treatment, access and lifestyle are all important factors to discuss and help both doctor and patient to take more holistic approaches to care.

When Garson is treating patients, Tazverik® (tazemetostat) is one option she considers for appropriate patients.

With any medication, Garson believes it’s important to set and manage expectations from the onset. “Every patient is going to react differently when it comes to treatment,” she says. “That’s why I always like to remind my patients that they have a say in their care and determining what treatment is a good fit for them.”

Looking Ahead

The past decade has brought important advances across the board in hematology, particularly for non-Hodgkin lymphomas like follicular lymphoma.iv

“The past five years is what gets me excited for the next decade—we’ve seen so many advances across the board in hematology which will continue to inform how we approach care as we move down the road.”

“It’s been a whirlwind of innovation in the way cancer is diagnosed and treated, and it’s not slowing down any time soon,” reflects Garson. “It’s just the beginning of a patient-first transformation of cancer care.”

IMPORTANT SAFETY INFORMATION [CONTINUED]

Warnings and Precautions

• Secondary Malignancies

The risk of developing secondary malignancies is increased following treatment with TAZVERIK. Across clinical trials of 758 adults who received TAZVERIK 800 mg twice daily as monotherapy, myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), or B-cell acute lymphoblastic leukemia (B-ALL) occurred in 1.7% of patients. One pediatric patient developed T-cell lymphoblastic lymphoma (T-LBL). Monitor patients long-term for the development of secondary malignancies.

• Embryo-Fetal Toxicity

Based on findings from animal studies and its mechanism of action, TAZVERIK can cause fetal harm when administered to pregnant women. There are no available data on TAZVERIK use in pregnant women to inform the drug-associated risk. Administration of tazemetostat to pregnant rats and rabbits during organogenesis resulted in dose-dependent increases in skeletal developmental abnormalities in both species beginning at maternal exposures approximately 1.5 times the adult human exposure (area under the plasma concentration time curve [AUC0-45h]) at the 800 mg twice daily dose.

Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TAZVERIK and for 6 months after the final dose. Advise males with female partners of reproductive potential to use effective contraception during treatment with TAZVERIK and for 3 months after the final dose.

Adverse Reactions

In 99 clinical study patients with relapsed or refractory follicular lymphoma receiving TAZVERIK 800 mg twice daily: Serious adverse reactions occurred in 30% of patients who received TAZVERIK. Serious adverse reactions occurring in ≥2% were general physical health deterioration, abdominal pain, pneumonia, sepsis, and anemia. The most common (≥20%) adverse reactions were fatigue (36%), upper respiratory tract infection (30%), musculoskeletal pain (22%), nausea (24%), and abdominal pain (20%).

Drug Interactions

Avoid coadministration of strong or moderate CYP3A inhibitors with TAZVERIK. If coadministration of strong or moderate CYP3A inhibitors cannot be avoided, reduce TAZVERIK dose.

Avoid coadministration of moderate or strong CYP3A inducers with TAZVERIK, which may decrease the efficacy of TAZVERIK.

Coadministration of TAZVERIK with CYP3A substrates, including hormonal contraceptives, can result in decreased concentrations and reduced efficacy of CYP3A substrates.

Lactation

Because of the potential risk for serious adverse reactions from TAZVERIK in the breastfed child, advise women not to breastfeed during treatment with TAZVERIK and for one week after the final dose.

To report SUSPECTED ADVERSE REACTIONS, contact Ipsen Biopharmaceuticals, Inc. at 1-855-463-5127 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Please see full Prescribing Information.

TAZVERIK is a registered trademark of Epizyme, Inc., an Ipsen company.

January 2025 TAZ-US-003534 

i Kaseb H, Ali MA, Gasalberti DP, et al. Follicular Lymphoma. [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538206/

ii https://lymphoma.org/wp-content/uploads/2023/01/LRF_Follicular_Lymphoma_RR_Factsheet.pdf

iii Hanel W, Epperla N. Evolving therapeutic landscape in follicular lymphoma: a look at emerging and investigational therapies. J Hematol Oncol. 2021 Jun 30;14(1):104. doi: 10.1186/s13045-021-01113-2. PMID: 34193230; PMCID: PMC8247091.

iv Rajamäki A, Hujo M, Sund R, Prusila REI, Kuusisto MEL, Kuitunen H, Jantunen E, Mercadal S, Sorigue M, Sancho JM, Sunela K, Kuittinen O. Mortality among patients with low-grade follicular lymphoma: A binational retrospective analysis. Cancer. 2022 Jul 1;128(13):2474-2482. doi: 10.1002/cncr.34221. Epub 2022 Apr 13. PMID: 35417924; PMCID: PMC9325396