Thursday, July 20, 2017

I Don't Care About What Caused My Cancer

As some of you may remember, this past spring I went to a conference for online health advocates. It was a good experience for me -- I had never thought of myself as an "advocate," and using that word made me rethink a lot of what I do.

So I've been more active on Twitter (follow me at @Lymphomaniac), and I have contributed more to the Facebook groups that I belong to that are dedicated to lymphoma. I'd love to do something with video, but that's a lot of work (and I don't know if I have the face for video....).

The other thing I said I would try to do was write more, and publish in places other than Lympho Bob. As far as advocacy goes, it would be nice to try to reach a larger audience.

Well, yesterday, I started that journey. A site called The Mighty published one of my pieces as one of their Featured Stories. The Mighty publishes articles written by patients, caregivers, doctors, and others, who live with cancer, chronic illnesses, mental health issues, and other conditions.

My piece is called "I Don't Care About What Caused My Cancer," and I invite you to click on the link and read it (and share it with anyone else that you think might like it). It touches on some familiar themes -- the emotional side of being a Follicular Lymphoma, not dwelling on the past, and living with hope. I enjoyed writing it, and I hope you enjoy reading it.

I'm hoping to keep finding places to share my writing and reach more people. I'll let you know when I do. (But the blog will always be my first Lymphoma Love....)

Thanks again for reading.

Monday, July 17, 2017

Doctor Who and Cancer

It' s been a busy week. Little time for reading and writing about cancer.

But I did catch the news yesterday that there will be a new lead on Doctor Who.

If you aren't a fan, Doctor Who is a British science fiction TV series that started over 50 years ago. The main character, The Doctor, can travel through space and time, and so goes around the universe saving people (and non-people) whenever there is trouble. (That's not a great description, but I think it's as accurate as you can get in one sentence.)

When the series started in the 1960's, the lead actor got sick and had to quit. The show was popular, so the people in charge decided that the character would have a unique feature -- instead of dying, he would regenerate, coming back to life as a completely different person (or, at least, different looking, since he was still The Doctor, with the same past -- or future, since he can travel through time). It was a smart move, since it allowed different actors to play the same role. It's a big reason why it's been on TV for more than 50 years.

The big deal about the new Doctor is that, for the first time, the character will be played by a woman, Jodie Whittaker. There has been talk for a few years about this possibility, and a lot of people were (and are) upset about it. The Doctor has always been a man. But, since the character can regenerate into any person, there is no reason why (other than tradition) he can't take the form of a woman.

Now, I generally avoid controversial topics, and among Doctor Who fans, this is about as controversial as it gets. But I'm going to come out and say (for those of you who are fans of the show, and who care) that I am in favor of the new female Doctor.

And for those of you who aren't fans of the show, you may want to care anyway.

You don't need to read Lympho Bob for too long to understand that I am forward-thinking. By that, I mean that I look forward to the future. The past is done. The present is important. But the future is where the real fun is. You know I get excited about pre-clinical trial research -- treatments that might not be available for another 10 years. That's fun to me.

And that's what Doctor Who is all about -- what comes next. Not just because The Doctor can jump ahead to the future, but because he (or she) can become someone completely new. He (or she) can regenerate.

One of the questions that has always fascinated me as a cancer patient has been, If cancer changes us, then who do we become? Do we really change? Does all of us change? Or just part of us? And is it change for the good? And how much of that change to we control?

I do think part of us changes, though probably not all of us. And I do think we can control that change, or at least a lot of it. And if we want it to be a good change, then we can make it that way. And because, for many of us, Follicular Lymphoma is a disease that will stay with us for a long, long time, we have that much more time to think about the changes we want to see.

So I'm all in favor of the new, female Doctor. She represents the kind of change -- and hope -- that I have come to look forward to as a cancer patient.

(Did I mention that The Doctor is all about Hope? The new Doctor even mentioned that when it was announced that she would play the role: "It's more than an honour to play the Doctor. It means remembering everyone I used to be, while stepping forward to embrace everything the Doctor stands for: hope. I can't wait." She gets it.)

So I can understand the fans of the show who don't like the change. But I also know that, as a cancer patient, change is unavoidable, and very often good. And even if we can't control the things that change, about us or the world or about the things we love, we can certainly control the way we react to it all.

And as often as I can, I choose excitement, anticipation -- and hope and regeneration.

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And thanks, once more, to all of you who voted for me for the WEGO Health Awards. You're the best. The voting will go on until September. I will keep you updated.

Tuesday, July 11, 2017

Vote for Best Blog

I am pleased to announce that the Lympho Bob has been nominated for two awards from WEGO Health.

WEGO Health is a company that matches patient advocates with health care businesses and organizations, helping to make sure that patient voices are heard. For six years, they have also sponsored awards for health advocates.

I have been nominated for Best in Show: Blog and Best Kept Secret. There are 16 awards, and dozens  of really excellent nominees. It's very cool to be nominated. As I've said before, I'd keep writing the blog even if I was the only one who read it, but a little recognition is nice, too.

The awards are now in the Endorsement phase, which means people can vote to endorse the nominees for the awards. If you are so inclined, you give me your endorsement by clicking here.

And here's a bonus -- you'll get to see my picture and learn my real name (which isn't Lympho Bob, or Bob Talisker -- my email address isn't my name, it's my favorite scotch).

You can only vote for each nominee one time, so they will ask you for an email address, to ensure you have only voted once. If that's a turn off, no problem. Your being a loyal reader is good enough for me.

Once again, thanks for all your support. More good stuff coming soon.


Saturday, July 8, 2017

Rituxan Biosimilars for Follicular Lymphoma

There has been a bunch of news about biosimilars for Rituxan in the last month or so. Again, this is kind of old news, but it's worth mentioning because it affects so many people -- there is biosimilar news for Europe and the U.S.

First, some background.

When treatments like Rituxan are approved, they come with a time limit. No one else is allowed to sell something similar for a set period of time. This is fair -- the company that developed the treatment spend many years and a lot of money working on the treatment in the laboratory, then through clinical trials, and then regulatory processes. That period of time gives the company exclusive rights to the treatment, letting them make up those costs and earn a profit.

After that period of time, other companies are allowed to develop copies that are probably cheaper. (They are cheaper because the company that developed them also has to market them and get people to want them. Companies that make the copies don't need to pay for marketing and advertising.)

Those copies can take different forms. Most of us are familiar with generics. You get a headache, you can buy Tylenol or another brand-name painkiller. Or, for a little less, you can buy acetaminophen, a generic version. Generics are fairly easy to create. They follow a chemical formula. Mix up the elements the same way (a little carbon, some hydrogen, whatever), and you'll get the same thing every time.

[In school, I did really well in biology, and really NOT well in chemistry. You probably suspected that.]

Biosimilars are different than generics. Generics are about chemistry, with atoms that will always behave the same way, and give a predictable result. Biosimilars are about biology -- living things -- and they don't always behave the way we would like them to. So creating a biosimilar is harder. It needs to behave the same way, go after the same protein on the surface of the cancer cell (CD20), stay in the body for the same length of time, spread around the body in the same way, be as safe, and be as effective for a long time. That's a lot for a copy to do.

And yet, some companies have managed to create biosimilars for Rituxan, and they seem to be working.

About a week ago, the FDA (in the U.S.) accepted an application for CT-P10, a biosimilar for Rituxan. The decision for this will probably come in early 2018. (It's trade name will be Truxima, and the FDA request is based on some really good trial results presented at the International Conference on Malignant Lymphoma in Switzerland last month.)

About 3 weeks ago, the European Commission approved a biosimilar for Rituxan (known as MabThera in Europe). The biosimilar is called Rixathon.

Acellbia, another Rituxan biosimilar, will probably be approved next month in India. It is already approved in Bolivia and Honduras under the name USMAL.

Patients and doctors will have the option to go with Rituxan (and I'm sure many will), or with the biosimilar. Insurance companies and healthcare systems that pay for the treatment might be more enthusiastic about the less expensive alternative.

The important thing, to me as a patient, is that we have options. If, for example, an insurer is able to lifetime cost cap, then a cheaper treatment with similar safety and results is obviously a very good thing, especially for a disease like Follicular Lymphoma that might require many different treatments over time.

And this is probably a good time to say Thank You to Rituxan. you've given me seven and half good years without treatment, and probably extended the survival of thousands of Follicular Lymphoma patients. We certainly owe you that much.



Wednesday, July 5, 2017

Rituxan Injections for Follicular Lymphoma

This news is a few weeks old now, but it's worth mentioning in case anyone missed it: The FDA has approved subcutaneous injections for Rituxan.

That means you may not need an IV infusion to get Rituxan anymore. You can get a shot under the skin instead.

(Barbara mentioned this in a comment a couple of weeks ago, and when I first wrote about this possible approval a couple of weeks ago, Popplepot commented about his experience with it. More on that below.)

The new treatment has a slightly different formula, so it's going by a different name -- Rituxan Hycela. It will include the same stuff that is in the IV version of Rituxan, plus Hyaluronidase, an enzyme that helps thin out something called Hyaluronan, a substance that surrounds the cells. The Hyaluronidase will make it easier for the Rituxan to get where it needs to go.

The biggest advantage of Rituxan Hycela will be the time it take to administer. A shot under the skin will take minutes, while the IV (as many of us know) can take hours. This is an excellent Quality of Life improvement -- we can get out of the doctor's office that much quicker.

When I wrote about this a few months ago, I called it "a shot in the arm" for Rituxan. (For those of you unfamiliar with the expression, it means a boost or an encouragement.) But I got that wrong -- Rituxan Hycela won't be given in the arm.

I'll let Popplepot describe how he received it, in a comment he left on that post that I linked above (it's been approved in the EU since 2014):

Hi Bob, I had sub cut half way through my ritux only treatment, it is administered by a tummy injection, I often joked with the nurses that I removed my six pack for a 24 pack so they had a fatter tummy to inject. It is a fantastic advance in and out in 15 minutes pretty painless sits under the skin like a gel for a day or so, I could make a smiley face by drawing with my finger on the injection site that would last for 15 mins or so lol, a bit strange you may think but I always try to bring humour to my diagnosis, especially in front of my very much loved family, i think when I smile and laugh they smile and laugh inside that Dad/ Husband/son is coping, privately it's hard but I won't let it be hard on them through me. Hope this makes sense 😉 

I replied that I thought his smiley face was disgusting and hilarious, and I wished I had this when my kids were small.

(Thank you again, Popplepot, for the information, and for having a great sense of humor about all of this. It's a way of looking at things that I absolutely agree with.)

(And thanks again, Barbara, for alerting me about the news a couple of weeks ago.)

The Rituxan Hycela shot can only be given to patients who have had one full dose of IV Rituxan. This makes sense -- the slower infusion will allow doctors and nurses to see if the patient had an allergic reaction. This will give them more time to deal with it. Once they know how to deal with it, the faster injection can be used.

So it won't be a complete replacement for IV Rituxan, but it could replace most of the time-consuming IVs that a patient gets. I have also see the injection as saving money, since the patient will spend less time being observed by a health professional. However, I haven't seen any breakdown of lower costs.

Hyaluronan
HyaluronanH
hyaluronidaseHyaluronidase

Thursday, June 29, 2017

Two Excellent R-Squared Studies for Follicular Lymphoma

It seems to me that the combination treatment that has gotten the most excitement from researchers in the last 5 years has been R-squared -- Rituxan + Revlimid (also known as Lenalidomide). Even when research results seem kind of mediocre to me, researchers comment on how great R-Squared is.

And now there are a couple more reasons for them to be excited. Both came from research that was presented this month at the 2017 International Conference on Malignant Lymphoma in Luagano, Switzerland.

The first study looked at R-Squared in Follicular Lymphoma patients who had not had any previous treatments. Results were excellent, with 95% of the 66 patients getting a response, and 72% of them getting a Complete Response. More importantly, The 5 year Progression Free Survival rate was 70%.

Seems like something that worth getting excited about.

The other study looked at a different population -- FL patients who had been heavily treated, with some of the 160 Follicular Lymphoma patients in the study having already received up to 9 previous treatments.
2017 International Conference on Malignant Lymphoma210

For this study, patients received R-Squared, and were then given maintenance of either straight Rituxan, or more R-Squared.

Results were, again, very strong, especially since this group was either double refractory to immunochemotherapy (both Rituxan and traditional chemo had stopped working), or had "high risk" FL, or had relapsed early (within 2 years after diagnosis and first treatment).

Of the 50 FL patients who were double refractory, the Overall Response was 45%, with a 21% Complete Response rate. The 1 year PFS for this group was 65%.

Of the 52 FL patients who relapsed early, the Overall Response was 47%, also with a 21% Complete Response rate. The 1 year PFS for this group was 49%.

Of the 60 FL patients who were considered High Risk, the Overall Response was 66%, and the 1 year PFS for this group was 70%.

This second study was a phase III clinical trial, which means it could be ready for FDA approval soon.

It is worth noting that, for all the excitement R-Square creates, it has not been approved yet by the FDA for any Follicular Lymphoma patients. there have been concerns about Lenalidomide/Revlimid's toxicity for a while. In this second study, there were several side effects, including several types of low white blood cell counts that could lead to higher risk of infection, fever, and blood clots. 

But overall, these studies seem to add to the happy feelings that lymphoma researchers have about the combination.  Another arrow in the quiver -- perhaps soon.

[Note: I usually give links to the conference abstracts for something like this, but I'm having trouble accessing them, so you're getting links to reports about them instead.]
The 1-year progression-free survival (PFS) rate was 70% with rituximab and lenalidomide. In the double refractory and early relapse groups, the 1-year PFS rates were 65% and 49%, respectively. In the early relapse group, the 1-year PFS was similar in those who received frontline rituximab/chemotherapy (n = 39; 52%) and those received a non-rituximab chemotherapy regimen (n = 13; 44%). In high-risk patients, the 1-year PFS rate was 70%.


The 1-year progression-free survival (PFS) rate was 70% with rituximab and lenalidomide. In the double refractory and early relapse groups, the 1-year PFS rates were 65% and 49%, respectively. In the early relapse group, the 1-year PFS was similar in those who received frontline rituximab/chemotherapy (n = 39; 52%) and those received a non-rituximab chemotherapy regimen (n = 13; 44%). In high-risk patients, the 1-year PFS rate was 70%

Friday, June 23, 2017

CAR-T Videos

There's a whole lot of really good stuff coming out of three important meetings for blood cancer specialists this month. I've already written a lot about presentations at ASCO, and there are also two great meetings happening in Europe.

Unfortunately, I'm in the middle of dealing with a small flood in my basement, and I haven't been able to read and write as much as I'd like, so I'm going to give you a couple of videos instead.

I'm seeing lots of very excited oncologists talk about all of this on Twitter, and I have to say, the thing that is generating the most excitement is CAR-T. Early results are excellent, and updated results are still very strong.

The first video is a long one (about 17 minutes), and features Prof. Stephen Schuster, a lead researcher on CAR-T. He explains in a lot of detail how CAR-T works, if you're looking for a fairly easy-to-understand summary.  The link comes from the blog CAR-T and Follicular Non-Hodgkin's Lymphoma, which features updated links to research and commentary about CAR-T. It's put together by Ben, an FL patient who had great success with CAR-T, and Will, whose wife also has had success with the treatment. Both of them are regular commenters here. If you're looking for an excellent source of information about CAR-T and FL, that's the place to go.

The second video present some of the same information as Dr. Schuster's, but in much shorter form. It features Dr. Jeremy Slade Abramson, who has done some research on CAR-T as well.

It's easy to see whay lymphoma researchers are so excited about this treatment.

Enjoy. I'll get back to some more of the good news about Follicular Lymphoma soon.