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Key Points for Decision Makers
As patients with R/R FL progress through treatment lines their economic and healthcare resource utilization burden generally increases. |
A lack of real-world economic and healthcare resource utilization data for newly approved treatments has led to a considerable gap in assessing the value of these therapies to stakeholders. |
Introduction
Follicular lymphoma (FL) is the most common indolent non-Hodgkin’s lymphoma (NHL) and is responsible for about 20% of all lymphoma cases in the USA [1]. Patients are often diagnosed with advanced disease, which is associated with an increase in mortality rate [2]. While some patients with FL may not immediately require treatment, the decision to treat is often based on the presence of symptoms [3, 4]. FL is treatable, but not curable, and patients will often relapse after a period of remission and become refractory to treatment [5]. As patients progress through treatment lines, the length of remission generally decreases, as does quality of life, while the economic burden increases [6, 7, 8–9].
There is currently no gold standard regimen or treatment sequence for patients with R/R FL. Chemoimmunotherapy regimens and lenalidomide + rituximab (R2) are included as preferred regimens in the second-line (2L) setting in the National Comprehensive Cancer Network (NCCN) Guidelines [10]. Third-line (3L) and subsequent therapy preferred regimens include mosunetuzumab, axicabtagene ciloleucel (axi-cel), and tisagenlecleucel (tisa-cel). Tazemetostat, and zanubrutinib + obinutuzumab are included as other recommended agents.
Recently approved therapies by the US Food and Drug Administration (FDA) include the EZH2 inhibitor tazemetostat and anti-CD19 chimeric antigen receptor T-cell therapies (CAR-T) including axi-cel and tisa-cel, as well as the bispecifics mosunetuzumab and epcoritamab [11, 12, 13, 14–15]. These therapies have shown significant promise in clinical trials and expand the treatment options for patients with R/R progressing to later lines of treatment [16, 17, 18–19]. Zanubrutinib, a Bruton tyrosine kinase inhibitor (BTKi) received accelerated approval in R/R FL by the FDA in March 2024. Each of these classes of therapies represents a unique approach to treatment, with differences not only in efficacy and safety but also production, delivery, administration setting, and duration of therapy. The differences in economic and healthcare resource utilization (HCRU) outcomes will be a critical component in quantifying the value of these therapies to patients and health...