Monday, May 26, 2014

ASCO: Lenalidomide (Revlimid) for Follicular Lymphoma

More from ASCO: Great results from a phase 2 trial of Lenalidomide in Follicular Lymphoma patients who have not yet had any treatments.

So let's get a couple of things straight right off. First, this is a study of Lenalidomide, also known as Revlimid, and Rituxan. The combination is often known as R + R, or R-squared, so I'm going with calling it "Revlimid," for the poetry.

Second, this is a look at R + R is Follicular Lymphoma patients who had not yet received any treatment. There was already a phase 2 trial, with results presented at last year's ASH conference, that showed how well R + R worked for patients who had already had some treatment, as well as a few who had been untreated.

There seem to be a bunch of teams working on R + R in Follicular Lymphoma, and this one is kind of stellar. It includes Lymphoma Rock Stars John Leonard and Bruce Cheson, for example.

As for the study: the team looked at 65 patients (a pretty small number, though to be expected in a phase 2 trial). 50 of them were able to receive the R + R. 72% of them achieved a Complete Response, and it came pretty quickly. (The median time to CR was 10 weeks, and 92% of CRs came within 24 weeks. The study involved 12 28-day cycles. Seems fast to me.) There was no correlation between CR rate and FLIPI score, disease grade, or bulky disease. In other words, this stuff worked no matter where they were at on their lymphoma journey.

The researchers conclude that the numbers justify moving on to a phase 3 trial with more patients, because the numbers were comparable to treatment with chemotherapy. More importantly, the numbers are even better than those presented at the ASH conference, where 42% of untreated patients had a Complete Response (compared to the 72% here).

This is all fantastic news.

The ASH presentation was interesting because it tried to explain how R + R (especially Revlimid) works. Basically, it helps keep things working that are supposed to be working, and that stop working when cancer comes along. So R + R works by helping the body work naturally, like encouraging Killer T Cells to wipe out things that don't belong (like cancer cells).

I'm sure this will lead to yet another phase 3 trial for R + R. It will be interesting to see how it all goes down in a larger trial, over a longer term, particularly with long-term side effects.

But for now, we'll call this one a win.

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