Saturday, June 15, 2013


As I said last week, I figured someone would do a summary of the good stuff from ASCO, and now Medscape has just such a summary, featuring Lymphoma Rock Star Dr. Bruce Cheson and Dr. Gilles Salles, who's pretty darn good himself (and who was featured in a Patient Power video about ASH that I linked to recently). The two discuss some of the take-aways about lymphoma (in general, not just Follicular Lymphoma) from the ASCO conference.

They say there are four pretty noteworthy trends:

1) Chemo has disappeared. There are no new traditional chemotherapies being developed for lymphoma, and I can't imagine there will ever be anymore ever again. The old stuff (Bendamustine and CHOP, for example) will hang around for a while, but with so much immunotherapy, biological treatments, kinase inhibitors, etc. etc. being developed, the "shotgun" approach of chemo is pretty much a thing of the past. Chemo will hang around, like a used car with a tape deck, because we all have the high school mix tape still sitting under the front seat; but from here on out, we're all mp3, folks. Metaphorically speaking, of course.

2) That said, there was still lots at ASCO on targeted-therapy combos: new treatments that home in on lymphoma cells, but combined with traditional chemo or monoclonal antibodies to increase their effectiveness. Kinase inhibitors are big among targeted therapies these days, especially GS-1101/Idelalisib and Ibrutinib. They seem less likely at the moment to give a Complete Response that lasts, so the combos are a better bet. The problem there: the companies that make them don't play nice together, and they cost a whole bunch of money.

3) How should we approach Follicular Lymphoma? Should we try for a cure? Or are we better just treating it as a chronic disease and accept that we should hold it in check for the rest of our lives? Dr. Salles thinks we shouldn't give up on a cure (and I agree), though treatments that hold things in check are a good idea. Still, he's not crazy about the idea of someone taking pills for his entire life (and Cheson implies that this would benefit drug companies more than patients, which is part of what makes him a Rock Star). But Gilles isn't convinced that, over time, we won't see more mutations of clone cells (that is, the cancer cells will find a way to change and thus resist the treatments), so he's not ready to throw out chemo just yet.

4) PETs were also a topic at ASCO. They are used for initial staging and response checks (and endpoints -- determining if a treatment really worked). Maybe we don't need repeated PETs, though, as checks between treatments? Other ways of checking might work as a way of measuring growth of the disease without so much radiation exposure. I'm with Drs. Cheson and Salles on this, and so is my own Dr. R; until a blood test or a physical exam shows a reason for a PET, I'm probably not getting one. (Though every now and then, I think I'd really like one, just to check that everything is OK with those deeper nodes that aren't so close to the surface.)

So, this isn't all necessarily about Follicular Lymphoma, but it's a pretty nice summary of some very up-to-the-minute trends from two guys who know what they're talking about.

Lots to look forward to in there.

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