b'Figure 1. Novel targeted therapeutic classes in follicular lymphoma (FL). Schematic diagram of novel agents grouped according to their mechanism of action. Abbreviations: BCR, B-cell receptor; PI3K, phosphatidylinositol-3-kinase; BTK, Bruton tyrosine kinase; SYK, spleen tyrosine kinase; mAb, monoclonal antibody; PD-1, programmed death-1; CAR, chimeric antigen receptor; NK, natural killer. Source: https://www.mdpi.com/2075-4426/11/2/152u From Page 47While research into the earliest stages of FL mayinhibitors and combinations for follicular lymphoma ultimately provide interventions that can prevent itsor announced they are pulling their applications for developmentinfuturepatients,advancesintreat- the indication, including umbralisib/obinutuzumab, ment options can help individuals who have the dis- umbralisib/ublituximab, umbralisib alone, duvelisib ease today.and idelalisib. Copanlisib is the only PI3K remain-ing on the market for FL.Shakeup in Treatment Options Newerdrugsapprovedforfollicularlymphoma Patients diagnosed with FL typically start treatmentincludetazemetostatforpatientswithmutated withimmunochemotherapyorrituximabmono- EZH2, about 20% of FL cases, and those with no therapy. Those who do respond or relapse within 24other good options. An oral drug, it is less immuno-months have a worse prognosis and may benefit fromsuppressive than many other options and has mini-autologous hematopoietic stem cell transplantation ormal side effects, making it particularly appropriate treatment with a chimeric antigen receptor T-cell ther- forfrailandelderlypatients.Mosunetuzumab,a apy. The U.S. Food and Drug Administration has ap- bispecific antibody that targets CD20 and CD3, is proved three in the last two years: lisocabtagene mara- another new therapy for FL.leucel, axicabtagene ciloleucel, and tisagenlecleucel.1Rhee J, Birmann BM, De Roos AJ, Epstein MM, Martinez-Maza Because of their toxicity, CAR-T therapies are mostO, et. al Circulating immune markers and risks of non-Hodgkin suitable for younger patients with aggressive disease. lymphoma subtypes: A pooled analysis. Int J Cancer. 2023 Mar Patientswhorelapseafter24monthswilllikely1;152(5):865-878. doi: 10.1002/ijc.34299. Epub 2022 Oct 5. PMID: needmultiplelinesoftherapyoverthecourseof36151863; PMCID: PMC9812887.decades. Some drugs that have been used in this set- 2Levin LI, Ramirez CM, Liao EL, Guo H, et. al. Longitudinal Changes in Immune Activation Serum Biomarkers Prior to Diagnosis and ting have been withdrawn in the last two years; oth- Risk of B-cell NHL Subtypes.Cancer Epidemiol BiomarkersPrev. 2023 ers have gained approvals.Feb 6;32(2):233-241. doi: 10.1158/1055-9965.EPI-22-0247. PMID: Notably,manufacturersarenolongersupport- 36409490; PMCID: PMC9905313.ingseveralphosphoinositide3-kinase(PI3K) 49'