Andrew D. Zelenetz, MD, PhD, Chair of the Non-Hodgkin Lymphoma Guideline Panel of the National Comprehensive Cancer Network (NCCN) and former Chief of the Lymphoma Service at Memorial Sloan-Kettering Cancer Center, New York, commented on the study by Yamshon et al for The ASCO Post.

He said the finding that serum cytokines may predict response to “R-squared” treatment was “intellectually interesting” but perhaps not clinically relevant, at least in follicular lymphoma.

“When we give rituximab and lenalidomide to patients with follicular lymphoma, the response rates are enormously high—close to 100%—and complete response rates are around 80% in previously untreated patients, in trials to date,” he noted.

In other words, biomarkers are useful for predicting response, but with near-universal responses, its utility is unclear. Serum cytokine levels could conceivably be useful, however, in subtypes with less predictable response to the drugs, such as mantle cell lymphoma, he suggested.

“I would say it may be a predictor of early response, but we already know this combination is highly effective,” he said. “The question is, how robust are the data across different subtypes, and how practical and easy is it to perform these tests in the real world? Ultimately, it could be useful in certain circumstances, but it’s premature to say.” ■

Disclosure: Dr. Zelenetz is on the advisory board of and receives research support from Genentech/Roche and is a consultant for Hospira, Dr. Reddy’s Laboratories, and Celgene.