Monjuvi Combo Reduces Progression Risk in Follicular Lymphoma

Monjuvi added to Rituxan and Revlimid extended progression-free survival from 14 to 22 months in follicular lymphoma: © stock.adobe.com.

Monjuvi, when added to Rituxan and Revlimid, significantly improved outcomes for patients with relapsed or refractory follicular lymphoma, explained by Dr. Christina Poh, hematologist-oncologist at Fred Hutch Cancer Center and assistant professor at the University of Washington School of Medicine. This U.S. Food and Drug Administration (FDA)-approved combination is based on results from the inMIND trial, a large, double-blind, placebo-controlled study of 548 patients.

Poh noted that patients receiving Monjuvi alongside standard treatment lived approximatley 22 months without their disease worsening versus 14 months with Rituxan and Revlimid alone. In turn, the combination reduced the risk of progression by more than half. This improvement was seen across all patient subgroups, including those with higher-risk or aggressive disease.

She emphasized the trial’s careful design and diverse patient population, which mirrored real-world cases, including patients with treatment-resistant or quickly relapsing lymphoma. The trial’s focus on progression-free survival reflects the goal of maintaining long-term disease control.

CURE: How does Monjuvi, in combination with Rituxan and Revlimid, improve outcomes for patients with relapsed or refractory follicular lymphoma compared to existing treatments?

Poh: The FDA approval of the addition of Monjuvi to [Rituxan] and [Revlimid] is based on the results of the inMIND trial, and it represents very exciting news for our patients with relapsed refractory follicular lymphoma. The reason is because when Monjuvi was added to the usual treatment of [Rituxan] and [Revlimid], patients lived longer without their disease getting worse. On average, patients on this combination went about 22 months before their cancer progressed, compared to about 14 months with their standard treatment alone. This meant that the risk of the disease coming back or getting worse was reduced by more than half with the addition of Monjuvi. Most importantly, this benefit was seen in all types of patients, even those who had higher-risk disease or more aggressive disease.

What aspects of the trial’s design or patient population do you think were key to demonstrating the benefits of this combination?

There were a few important things about the trial that helped us show that this treatment can really help people with follicular lymphoma. First, the trial was designed very carefully. It was a large, well-controlled study that was randomized and placebo-controlled, so neither the patients nor the doctors knew who was getting the treatment or the placebo. This kind of study is considered the most reliable way to test if a treatment actually works.

Second, the trial included a wide range of patients, and that was reflective of who we doctors see in real life. It included patients who had tougher cases of follicular lymphoma, more aggressive cases, patients whose lymphoma didn’t respond to previous treatments, or who had their disease come back very quickly after their last treatment. The encouraging thing about this regimen is that this new treatment helped across all the different groups.

The main goal of the study was to see how long patients could live without their disease getting worse. This endpoint was especially important for patients with follicular lymphoma because the goal of new treatments is to see how long the disease can be controlled or kept away over time.

What should patients and caregivers know about the safety profile of Monjuvi when used in combination with Rituxan and Revlimid?

The safety profile of Monjuvi with [Rituxan] and [Revlimid] was manageable in the study, and it was consistent with what was expected from these therapies. Adding Monjuvi did not lead to any additional or unexpected side effects. The side effects that were noted were typically manageable with dose adjustments, supportive care, or temporary treatment holds. The combination did not introduce any new side effects.

Follicular lymphoma often requires multiple lines of therapy due to frequent relapse. How might this new treatment option impact long-term disease management and quality of life?

Follicular lymphoma is a chronic disease, and our patients often face multiple relapses over their lifetime. Having an effective, well-tolerated treatment option is crucial. The approval of Monjuvi combined with [Rituxan] and [Revlimid] offers a treatment option that not only improves progression-free survival but also has a manageable safety profile. This means patients can experience longer periods of disease control without the burden of more toxic treatments we usually consider as patients get more treatments over time.

Could you discuss the importance of having chemotherapy-free options like Monjuvi for patients with follicular lymphoma?

Yes, absolutely. Follicular lymphoma often requires multiple lines of therapy over a person’s lifetime. The importance of a chemotherapy-free approach is that it avoids some of the short- and long-term side effects of chemotherapy. For example, hair loss or bone marrow damage are two side effects that our patients and we as physicians worry about, and this regimen can avoid those.

What are some key considerations or advice you would give to patients who are newly eligible to receive this combination therapy following the FDA approval?

If you think you are newly eligible to receive this combination, I encourage you to talk with your healthcare team, have an open conversation about what to expect, how to monitor for side effects, and how this regimen fits into your long-term care plan. Ultimately, this approach will not only help manage the disease effectively but also prioritize quality of life and reduce the long-term risks associated with chemotherapy. But it’s important to use it appropriately and in the right setting.

Transcript has been edited for clarity and conciseness.

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