Wednesday, January 26, 2011

A Nice Combination

From the most recent issue of the medical journal Blood comes an article called "The combination of bendamustine, bortezomib and rituximab for patients with relapsed/refractory indolent and mantle cell non-Hodgkin lymphoma." The article describes the results of a phase 2 clinical trial that combined Bendamustine (Treanda), Bortezomib (Velcade), and Rituxan. Some very positive results from this one.

The article makes the point that all three treatments have been effective and are well-tolerated on their own, and that they act in different ways: Bendamustine is kind of a traditional chemotherapy; Bortezomib works by keeping cells from removing their own waste products and thus killing themselves; and Rituxan works by...well, no one is sure why it works, exactly, but it works. And it's different from the other two. So the clinical trial wanted to see what would happen if you combined the three treatments. Makes sense -- attack the cancer in three different ways. Mere months ago, another researcher suggested the same kind of strategy with CVP, Rituxan, and Zevalin. Same philosophy (hit the cancer cells from different directions, and increase your chances of not missing any), but with maybe just a tad less toxicity than you'd get from CVP.

In a nutshell, in this small study (phase 2 trials usually are small), 30 patients were given a specific course of the three treatments. Nearly all had some kind of response, and about half had a Complete Response. Very promising, especially since only one patient had significant side effects. See the link for more detail.

This trial went so well that a new phase 3 trial has opened up in multiple centers all over the country. I haven't seen the description yet, so I don't know how many patients they plan to enroll, or where it will be conducted, but it looks very promising. In my opinion (as an non-expert, very interested observer), I think this kind of combination of treatments is likely to be where treatment for Follicular NHL is headed. Until someone comes up with spomething better, anyway....

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