The medical journal Leukemia and Lymphoma just published a study called "Comparison of the Effectiveness of Frontline Chemoimmunotherapy Regimens for Follicular Lymphoma Used in the United States."
It looks at how well Follicular Lymphoma patients responded, over the long-term, to three traditional chemotherapy treatments, all with Rituxan: R-CHOP, R-CVP, and R-Fludarabine.
It made me think immediately of another study from Italy from last year (April 2013 Journal of Clinical Oncology) that looked at the same three treatments, and with similar results.
In the more recent study, which looked at patients in the United States, overall response rates were high for all three (R-CVP 87%, R-CHOP 93%, R-Fludarabine 94%). Five-year survival was higher in R-CHOP and R-Fludarabione (86%) that R-CVP (76%). Same with Progression-Free Survival after 5 years (R-CVP 49%, R-CHOP 58%, R-Fludarabine 64%). Similar to the Italian study, which looked at 3 year statistics.
When I wrote about that study a year and a half ago, my question was this: why bother with a study like this? Traditional chemo is halfway out the door. Do we really need to know that R-CVP won't do as good a job as R-CHOP, when we have so many other targeted options to choose from right now?
Looking back, it's kind of an unfair question, for a couple of reasons.
First, this study involves a 7 year follow-up. So the patients in the study were starting their treatment even before I was diagnosed. To be fair, those three options were on the table for me way back when. So it wouldn't be fair to tell those researchers that their life's work is useless at this point.
Second, their work really isn't useless. There's still a place for traditional chemotherapy in treating Follicular Lymphoma. I haven't seen anything that says R-CHOP, for example, isn't a valid option for transformed FL, though we are seeing more options being explored these days. And I know there are still some oncologists who go to chemo for a first treatment, whether or not there are other options available. If it's still happening, it's good to know what the best options are.
All that said, a study like this is still a reminder to me, more than anything, of how far we've come, and of how many options we have now -- better options than I had when I was first diagnosed. I remember, almost seven years ago, laying out for myself what I thought I would need to do when treatments failed: I'd start with Watching and Waiting, and then go to straight Rituxan. After that, R-CVP. Then R-CHOP. Then an Auto Transplant, and then, if my body could deal with it, an Allo.
Other than Rituxan, I can't say any of those things are even on my list any more.
And that's all changed in just six years.
I've been talking about Hope lately, and this is a great illustration of why we should be hopeful -- look how far we've come. How many of you have had a conversation with an oncologist about Fludarabine lately? How many of you even know what it is?
Now, I'm not saying I would never consider R-CHOP, or that an Allo Stem Cell Transplant is out of date. Those options are valid, and they are available.
But we have so much more to talk about now.
And so much more to be hopeful about.
How can you not be excited about the future?