4 CHU Montpellier, UMR CNRS 5535, Montpellier, France
David Cunningham
5 Royal Marsden Hospital, Sutton, United Kingdom
Martin J.S. Dyer
6 Ernest and Helen Scott Hematological Research Institute, University of Leicester, United Kingdom
John G. Gribben
7 Queen Mary, University of London, St Bartholomew’s Hospital, London, United Kingdom
Elizabeth H. Phillips
8 University of Manchester, The Christie Hospital and National Institutes of Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
9 Peter MacCallum Cancer Centre, the Royal Melbourne Hospital, and University of Melbourne, VIC, Australia
Andrew Grigg
10 Austin Hospital, Heidelberg, VIC, Australia
Judith Trotman
11 Concord Repatriation General Hospital, University of Sydney, Concord, NSW, Australia
Tong-Yu Lin
12 Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
Xiao-Nan Hong
13 Fudan University Shanghai Cancer Center, Shanghai, China
The phase III GALLIUM trial assessed the safety and efficacy of obinutuzumab-based versus rituximab-based immunochemotherapy in patients with previously untreated follicular lymphoma (FL) or marginal zone lymphoma (MZL). At the primary analysis, the trial met its primary end point, demonstrating improvement in investigator-assessed progression-free survival (PFS) with obinutuzumab-based versus rituximab-based immunochemotherapy in patients with FL. We report the results of the final analysis in the FL population, with an additional exploratory analysis in the MZL subgroup. Overall, 1202 patients with FL were randomized 1:1 to obinutuzumab- or rituximab-based immunochemotherapy followed by maintenance with the same antibody for up to 2 years. After a median 7.9 (range, 0.0–9.8) years of follow-up, PFS remained improved with obinutuzumab- versus rituximab-based immunochemotherapy, with 7-year PFS rates of 63.4% versus 55.7% (P = 0.006). Time-to-next antilymphoma treatment was also improved (74.1% versus 65.4% of patients had not started their next antilymphoma treatment at 7 y; P = 0.001). Overall survival was similar between the arms (88.5% versus 87.2%; P = 0.36). Irrespective of the treatment received, PFS and OS were higher in patients with a complete molecular response (CMR) versus those with no CMR (P < 0.001). Serious adverse events were reported in 48.9% and 43.4% of patients in the obinutuzumab and rituximab arms, respectively; there was no difference in the rate of fatal adverse events (4.4% and 4.5%, respectively). No new safety signals were reported. These data demonstrate the long-term benefit of obinutuzumab-based immunochemotherapy and confirm its role as a standard-of-care for the first-line treatment of advanced-stage FL, taking into account patient characteristics and safety considerations.
