Saturday, March 26, 2011

Follicular Guidelines

The National Comprehensive Cancer Network's conference took place last week, and there were some announcements there that are important to Follicular NHL patients.

The NCCN is an alliance of 21 of the top cancer centers in the country, inlcuding Dana-Farber in Boston, Sloan-Kettering in New York, MD Anderson in Texas, and a bunch of other really good places you'd want to go if you needed cutting-edge help. The NCCN makes recommendations for clinical practioners in oncology about how to treat certain cancers, with their guidelines based on the most recent and best research available. In other words, these are the people your doctor turns to when he or she wants to know what to do next.

At their conference, they announced some changes to their recommendations to the way fNHL patients are treated. None of them is terribly surprising, at least not to someone who keeps up with this kind of thing. (Like  me. And, since you're reading, you.)

First, they recommend that Bendamustine (Treanda) plus Rituxan be given top consideration as a first-line therapy. This means that oncologists should consider it as their first option. This replaces R-CHOP chemotherapy as their first choice, based on results of a study that showed Bendmustine + Rituxan was far more effective and had less toxicity than R-CHOP. Good news for me: while I didn't have it as my first line therapy, it is what Dr. R has in mind for my next one, whenever that comes. So it's nice to have some validation of that choice.

In some ways, I don't think this will change things too much. There's still no evidence that R-CHOP was the best first choice anyway; many, many doctors went with straight Rituxan, or R-CVP chemo, or F-R chemo, or just watching and waiting, instead of NCCN's recommended first therapy choice. Maybe it will mean less use of R-CHOP initially, and more doctors saving that option for transformed patients? But R-CHOP isn't going anywhere.

A second recommendation is to give more thought to post-remission therapy with Rituxan and radioimmunotherapy (like Bexxar or Zevalin). These recommendations, too, are based on impressive research results. Rituxan maintenance, which involves periodic doses of Rituxan after a patient has received successful chemotherapy, is already pretty common, if my support group members are any indication. More significant is the recommendation for RIT consolidation therapy, which would involve receiving RIT after chemotherapy has done its job. I haven't discussed RIT in a while, but if you've been reading, you know that RIT is one of those very underused therapies, for economic and practical reasons. This recommendation might give it a little boost, and encourage more oncologists to give it a try. RIT attacks cancer cells in a way that is very different from chemotherapy; that two-front battle approach just seems to make sense.

The NCCN also (re)affirmed the usefulness of PET scans, particularly in helping to assess patients who may have transformed. Glowing nodes on a PET scan will help determine which are most active, and thus most aggressive, and thus most worthy of being biopsied to check for transformed cells.

There's also some news about Posttransplant Lymphoproliferative Disorder (PTLD), a complication for people who have received a bone marrow transplant. To be honest, I feel like a transplant is so far down the road for me right now that I've lost track of what's going on in that world. Read the link yourself to find out more.

So, as I said, I don't think of any of this is especially surprising, but it is great to get the official validation from as influential a group as NCCN. It's a reflection of some of the changes that I have been following for the last three years or so, and a nice reminder of how much things have changed for the better since I was diagnosed (and maybe of how much more they'll change in the next few years).

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