Staying relevant.

It’s not easy for chemo these days. The phase 3 RELEVANCE trial randomized >1K patients with follicular lymphoma to upfront standard dealer’s choice chemo + rituximab versus the immunomodulator lenalidomide (aka Revlimid) + rituximab. The primary endpoints were complete response for 120 weeks (yes 120, as in >2 years) and progression free survival with a hypothesis that the lenalidomide arm would be superior. Well, neither outcome was any different making this a negative trial. But this Celgene-sponsored pub harps a lot on the difference in side effects, with febrile neutropenia occurring in 7% with chemo versus 2% with lenalidomide. On the other hand, grade 3-4 skin toxicity occurred in only 1% with chemo and 7% with lenalidomide. TBL: Rituximab with lenalidomide was not superior to rituximab with standard chemo for untreated follicular lymphoma, but Celgene would like us to point out it's not inferior either. Maybe give obinutuzumab a try, instead. | Morschhauser, N Engl J Med 2018