Friday, March 28, 2014

Vorinostat! Zolinza!

Before I get into this, let me just say how great the name Zolinza is for a cancer drug. It's kind of hard to say it without smiling. Seems like there should automatically be an exclamation point after it, or maybe a few extra Zs at the beginning. Zzzzzolinza! I'd almost be happy to take it.

Oncologist: "Well, it looks like your Follicular Lymphoma has returned."
Me: "Gosh, doc, what are my options?"
Onc: "Well, there's Bendamustine. Or we could try Idelalisib. Or maybe.....Zzzzzolinza!"

And then the oncologist hands me a plate of guacamole and tortilla chips.



Anyway, a phase 2 study shows that Zolinza is effective for Follicular Lymphoma.

In a study soon to be published in the British Journal of Hematology, researchers gave Zolinza to 50 NHL patients, 39 of whom had Follicular Lymphoma, all of whom had relapsed form  a previous treatment (most of them had Rituxan + chemo).  About half of them showed a response, and the median Progression Free Survival was 20 months. There were some side effects, but for the most part, the results seem to justify a larger phase 3 study.

Zolinza is also known as Vorinostat. It has already been approved for relapsed Cutaneous T Cell Lymphoma (a skin-based lymphoma), so we have a pretty good idea of what we're dealing with. It has also been tried on some other blood diseases, and on small cell lung cancer.

Zolinza is another inhibitor, a treatment that doesn't aim to kill off cancer cells, but rather to stop a function that is crucial for the cancer cell's survival. In this case, it is a histone deacetylase inhibitor. It's kind of a cool mechanism to disrupt. In a nutshell, histone deacetylase is an enzyme necessary for DNA to function. It removes certain compounds from the DNA that keep it from wrapping up tightly. Since cancer cells rely on that rogue DNA to multiply, then interrupting that function will keep the cancer cells from multiplying.

As always, it's hard to predict where Zolinza will go from here, and what the results of the phase 3 trial will be. But I think it helps that this works through a mechanism that's different from others that are being explored or have been approved. If the trend really is to combine treatments in a way that attacks the lymphoma from a few different directions, then this one would certainly e worth exploring further.

Another potential arrow for the quiver.

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