Monday, April 15, 2013

R-CHOP for Follicular Lymphoma?

I guess you could label this one, "That's nice, but aren't you a little late?"

Italian researchers have completed a study on the best treatment for advanced Follicular Lymphoma. Results were published last month in the Journal of Clinical Oncology. Cure Today has a nice summary.

The results show that R-CHOP is the best choice, by several measures: Time to Treatment Failure and Progression-Free Survival, as well as the best Risk/Benefit ratio.

Here's the problem: in this study, R-CHOP was compared to R-CVP and R-FM (Fludarabine and Mitoxantrone). Not exactly cutting-edge treatments.

So, in a sense, kind of a useless study. R-CVP and Fludarabine are both certainly still used, though they are rapidly falling out of favor, with Bendamustine in the lead for our best Risk/Benefit choice, and a whole bunch of others -- non-chemotherapies -- close on its heals.

Which, in a way, makes the study very good news, too. It demonstrates just how quickly we're moving along. The lead researcher in the study admits that his results are already a little behind the times, as the Cure Today article says:

Dr. Federico agreed that bendamustine versus CHOP is now the central question. "Just (as) we solved the dilemma between R-CHOP and R-CVP, we are now (debating) the dilemma between R-CHOP and R-bendamustine," he said.

I remember, five years ago, soon after I was diagnosed, Dr. R saying Fludarabine was an option. No one really talks much about it now. Something that was more or less cutting edge just five years ago is more or less useless now.

Makes you wonder what things will look like in five more years, doesn't it? Bendamustine, a Cold War relic? Rituxan, like Al Gore, a shadow of the 90's? All those inhibitors, laughably out of date?

That would be pretty cool.


Anonymous said...

Hi! Ive been an avid reader of ur blog and just want to let you know that of all the blogs ive read i enjoy yours the most, its fun and easy to read and very informative, my husband is suspected to have follicular lymphoma, and we are waiting for the 2nd opinion from another lab, your blog gave us courage and hope. Thank you so much!

Anonymous said...

Same here, I have FL. Great informative Blog, keep on the good work!

Lymphomaniac said...

Thank you both so much. "Fun and easy to read and very informative" is exactly what I'm going for. I will do my best to keep it up.

And good luck to both of you on your lymphoma journies. Stay hopeful.

Rach Turner said...

When I was diagnosed in Aug 2011, my doctor felt that B-R was the best choice for my stage IV indolent FL. My insurance company wanted me to have R-CHOP, but doc felt B-R would be more, or as, effective with fewer side effects. Doc won and I did 6 rounds of B-R with good results. I'm doing 2 years of maintenance Rituxan now with only 4 treatments to go. It is amazing how far things have come in the few years before I was diagnosed. Doc tells me each visit how more and better treatments are in the pipeline. Lots to be encouraged by!

Lymphomaniac said...

Amen to that, Rachel. It's great that your doctor fought for you. From what I've read and heard, B-R is more effective and less toxic, so it seems like the much better choice. And glad to hear that the maintenance is working, too. I wish you continued good luck with it all.