Here, learn what you need to know about FL and treatment options available.
What is Follicular Lymphoma (FL)
Follicular lymphoma (FL) is a subset of non-Hodgkin’s lymphoma (NHL). It’s a slow-growing cancer that starts in the lymphatic system, which fights infection and some diseases. According to the American Society of Clinical Oncology, this lymphoma subtype typically accounts for 20 percent of all diagnosed NHL cases and is the second most common type of NHL.
The symptoms of FL include swelling of lymph nodes in the neck, underarms, abdomen, or groin, as well as fatigue. Less common symptoms include fever, night sweats, and weight loss. Many times, patients with FL are asymptomatic at the time of diagnosis. While FL can be diagnosed at any age, the average age at diagnosis is 60 years old.
“Follicular lymphoma can present differently in patients – some may have an indolent, or slow growing cancer, that we’ll often use a ‘watch and wait’ approach with, while others may need treatment immediately, and see their FL return, which tells us they have a more aggressive form of the disease,” said Dr. Ahmed Galal, who sees patients with FL at Duke Cancer Institute. “What’s important to keep in mind though, is that FL is considered a chronic disease because it is typically incurable, patients can live for many years with it.”
Living with FL
FL patients often experience periods of remission before the disease returns, also known as a relapse. Upon discovery that a patient’s cancer has returned, their doctor will make recommendations for the next course of treatment, taking multiple factors into consideration (e.g., length of time between treatments and lifestyle needs). For patients who relapse, they may find their cancer has become resistant to treatments they’ve received before.
Donna Johnson was one such patient. She was diagnosed with NHL in early 2015, and after undergoing successful chemotherapy treatment, she went into remission. However, just one and a half years later, Donna’s cancer returned. This time, she was diagnosed with FL.Courtesy Donna Johnson
“Before I was diagnosed and treated for NHL, I had a strange cramp in my calf muscle that wouldn’t go away, so I decided to mention it during a routine medical checkup, which ultimately led to doctors finding my cancer,” said Donna. “When that same cramp returned in 2017, I had a feeling the cancer was back, so I spoke with my oncologist. He advocated for a follow-up scan which showed that I had relapsed. Unfortunately, that relapse wasn’t the last one and my FL came back again in March 2019. I’m actively being treated for it today.”
FL Treatment Options
FL treatments vary, depending on the stage of the disease, a patient’s treatment history and other factors. In addition to the “watch and wait” approach, treatment options include chemotherapy, immunotherapy, radiation therapy, stem cell transplant, kinase inhibitors, or EZH2 inhibitors.
“Patients should work closely with their doctors to identify a treatment approach that works best for their individual needs,” said Dr. Galal. “It’s important to understand that FL treatment is not ‘one and done’. With each relapse, you and your doctor will work together to determine your next best treatment option. The great news is, the treatment landscape for FL has evolved rapidly in the last decade, leading to better outcomes for patients. It’s important to discuss these options and weigh which approach will work best for you.”
One available treatment option is TAZVERIK® (tazemetostat). TAZVERIK is approved by the U.S. Food and Drug Administration (FDA) to treat adults with follicular lymphoma when the disease has come back or did not respond to treatment, whose tumors have an abnormal EZH2 gene, and who have been treated with at least two prior medicines, or who have no other satisfactory treatment options. The approval of TAZVERIK in these patients is based on a study that measured the percentage of patients whose tumor shrank or disappeared after treatment and the length of their response. TAZVERIK is still being studied to confirm these benefits. It is not known whether TAZVERIK is safe and effective in children less than 16 years of age. TAZVERIK is associated with side effects and may not be suitable for every patient. Since everyone may react differently to treatment, it is important for patients to talk to their doctor about whether a specific treatment may work for them.
“TAZVERIK is an oral treatment, which can be taken at home. Many patients prefer an oral option, as it can be tiresome to travel to infusion centers and sit for hours in a chair to receive treatment,” said Dr. Galal. “This is especially relevant now during the COVID-19 pandemic.”
Donna understands the reality of the COVID-19 pandemic, and the importance of staying in touch with her doctors firsthand. She continues to schedule routine check-ins with her doctors to monitor her progress on treatment. Having regular conversations with healthcare providers via telemedicine, and in-person visits when proper safety precautions are in place, can help support overall health and identify signs of relapse.
“I visit my doctor’s office in person every three months, but I can reach out to my healthcare team anytime for questions via email or a call,” said Donna. “I encourage everyone currently managing cancer, and especially others with FL, to find a doctor they are comfortable with and to be your own advocate – ask questions, don’t be afraid to speak up when you feel something is wrong, and keep living life with a positive attitude.”
For more information about follicular lymphoma, visit the Lymphoma Research Foundation at www.lymphoma.org. For more information on TAZVERIK, including full Prescribing Information and Medication Guide, please visit the TAZVERIK site (link below).
What is TAZVERIK?
TAZVERIK is a prescription medicine used to treat:
- Adults with follicular lymphoma when the disease has come back or did not respond to treatment, whose tumors have an abnormal EZH2 gene, and who have been treated with at least two prior medicines. Your healthcare provider will perform a test to make sure TAZVERIK is right for you.
- Adults with follicular lymphoma when the disease has come back or did not respond to treatment, who have no other satisfactory treatment options.
The approval of TAZVERIK in these patients is based on a study that measured the percentage of patients whose tumor shrank or disappeared after treatment and how long that response lasted. TAZVERIK is still being studied to confirm these benefits.
It is not known if TAZVERIK is safe and effective in children less than 16 years of age.
Important Safety Information
What is the most important information I should know about TAZVERIK?
TAZVERIK can cause serious side effects, including:
- Risk of new cancers. An increase in new (second) cancers has happened in people who were treated with TAZVERIK. Talk with your healthcare provider about your risk of developing new cancers. Your healthcare provider will monitor you for new cancers after your treatment with TAZVERIK. Tell your healthcare provider if you are more tired than usual, or have easy bruising, fever, bone pain, or paleness.
Before taking TAZVERIK tell your healthcare provider about all of your medical conditions, including if you:
- Are pregnant or plan to become pregnant. TAZVERIK can harm your unborn baby. Your healthcare provider will give you a pregnancy test before you start treatment with TAZVERIK. Tell your healthcare provider right away if you become pregnant or think you may be pregnant.
- Females who are able to become pregnant should use effective non-hormonal birth control (such as condoms) during treatment and for 6 months after the final dose of TAZVERIK. Birth control pills (oral contraceptives) and other hormonal forms of birth control may not be effective if used during treatment with TAZVERIK. Talk to your healthcare provider about birth control options that are right for you.
- Males with female partners who are able to become pregnant should use effective birth control during treatment and for 3 months after the final dose of TAZVERIK.
- Are breastfeeding or plan to breastfeed. It is not known if TAZVERIK passes into your breast milk. Do not breastfeed during treatment and for 1 week after the final dose of TAZVERIK.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. TAZVERIK may affect the way other medicines work and other medicines may affect how TAZVERIK works.
What should I avoid while taking TAZVERIK?
- Avoid eating grapefruit or drinking grapefruit juice during treatment with TAZVERIK.
- Avoid taking St. John’s wort during treatment with TAZVERIK.
Talk to your healthcare provider before starting any new medications or supplements.
What are the possible side effects of TAZVERIK?
The most common side effects of TAZVERIK in people with follicular lymphoma include:
- Cold-like symptoms (upper respiratory infection)
- Bone and muscle pain
- Stomach (abdominal pain)
These are not all the possible side effects of TAZVERIK.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Please see full Prescribing Information for TAZVERIK and Medication Guide, available at www.tazverik.com.