Friday, April 26, 2013

First Choice for Follicular Lymphoma

I said I was going to write about Zevalin and RIT today, but I saw this and it was too important tpo pass up.

A few weeks ago, I wrote about an Italian study that suggested R-CHOP was the best choice for a first treatment of advanced Follicular Lymphoma. The problem was that this study only looked at R-CHOP versus R-CVP and R-FM, and other treatments (especially Bendamustine) have proven more effective with less toxicity. The study is certainly valid (and might mean the death of CVP), but isn't really timely.

So the question of which treatment is the best option for first-time Follicular Lymphoma patients remains open. Maybe R-CHOP won that three participant battle, but besides CHOP and Bendamustine, we also have watching and waiting, Our Old Pal Rituxan, and a host of other monoclonal antibodies, kinase inhibitors, and other stuff to choose from (now and in the near future).

The most recent Journal of Clinical Oncology has an editorial from Drs. Oliver Press and Maria Corinna Palanca-Wessels of Fred Hutchinson Cancer Center in Seattle, responding to the Italian study, called "Selection of First-Line Therapy for Advanced Follicular Lymphoma."

The authors agree that research has shown that, for advanced FL with symptoms, some combination of Rituxan and chemo is the way to go. (They leave aside the whole W & W issue, which is good -- they narrow things down to patients who clearly need some kind of treatment, though I would quibble that the W & W question isn't so clear cut in many oncologists' minds. Regardless, we continue....)

They review the Italian study, and point out some of its weakness, including its not paying attention to Overall Survival (that is, tracking whether patients died, no matter the cause), and focusing instead on Progression Free Survival. The lack of Overall Survival statistics make it harder to measure against other studies.

They also briefly mention the idea that more recent studies compare CHOP and Bendamustine, pointing out B-R's superiority.

So, the answer to the question of which is the best treatment for Follicular Lymphoma?

Sorry -- still up in the air. This article doesn't provide an answer for us.

And, frankly, I'm not sure we'll get one any time soon. But I think that's good news. We have so much in the pipeline that no one's going to want to say "Yes, this is it!" until we know that for sure. So I say take the bad news for the good news that it is: we don't have one single best option, we have a whole bunch of really good options.

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