The GALLIUM Poll.

The polls are in, and they tell us the first line treatment of follicular lymphoma is finally ready to branch out. For years, rituximab has been a standard addition to chemotherapy. But now there’s a new immunotherapy in town, and it promises to deliver longer life free from progressive disease. Results of the GALLIUM trial are out this month in NEJM. It’s design: >1200 patients with untreated follicular lymphoma stage IIX-IV were randomized to the standard rituximab (CD20 antibody) versus obinutuzumab (third generation CD20 antibody) in combo with and as two year-maintenance following site-specific chemo. So what does the third generation buy you? Glycoengineering and a 7% absolute increase in progression-free survival (PFS) at 3 years. This pub comes just days after FDA approval of copanlisib (PI3K inhibitor) for relapsed or refractory follicular lymphoma, accelerated by initial reporting of a 60% response rate in the phase II CHRONOS-1 trial to be followed by the randomized CHRONOS-3 edition. We’re not easily excited by all these PFS endpoints, but, when it comes to such an indolent disease with few effective treatment options, we’ll not dwell on poll imperfections.