Tuesday, October 7, 2014

Dr. Sharman on Indolent Lymphoma

I'm finally getting to Dr. Sharman's other recent post related to Follicular Lymphoma.This one is called "Immunotherapy for Indolent (Low Grade) Lymphoma."

In this post, Dr. Sharman looks at some of the "home runs" in research on Indolent Lymphomas. (Apparently, he's not a baseball fan, despite the baseball language. You'd think his time in Boston would make him a Red Sox fan. Alas, no.)

It's a pretty interesting list, and a quick tour of the way treatments have changed over the last 70 years or so: from chemotherapy, to Adriamycin (also known as Hydroxydaunorubicin, the "H" in CHOP), to Rituxan, Bendamustine, and treatments like Ibrutinib and Idelalisib that target pathways that allow lymphoma cells to survive.

His final "home run" is Immunotherapy. While this is a general category of treatments (and one that is very exciting to many cancer experts), Dr. Sharman specifically mentions the combination known as R-squared, Rituxan + Revlimid. He links to three studies that he thinks will "position this combination at the center of treatment pathways for patients with follicular lymphoma." That's certainly something to pay attention to, from an expert who is at the center of things going on right now.

I really like his explanation for how this combination works, so much that I want to just quote the whole thing: "I think of the combination of revlimid-rituximab (also called R2) as a road trip with a pot of coffee and a map.  Rituximab helps orient the immune system to go after the cancerous b cells by coating the outside of them and serving as an alarm for the T cells (like a road map).  Revlimid (lenalidomide) helps overcome what has been called T-Cell “pseudo-exhaustion” and get them to reactivate (ready for the road).  B cell cancers have a remarkable ability to “put the t cells to sleep.”  Whether though secretion of hormones, or actually manipulating the on/off switches of T cells, the cancerous B cells literally put the other half of the immune system into a post thanksgiving meal food coma.  Revlimid acts like a cold splash of water to the face for the sleepy T cells.  Not bad for a drug that really isn’t chemotherapy but is considered an “imid” for – immunomodulatory drug."

[Those links are from his original post.]

So, another great blog post from Dr. Sharman -- an informative look at our history, and an intriguing statement about what be in our near future. We'll keep an eye on those three R + R studies that he mentions, and hope that he's right.

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