Monday, November 24, 2014

ASH: Bendamustine + Zevalin

I think my ASH posts over the last couple of weeks have been kind of mixed. A couple of negative ones. I don't like writing those, but I think they're necessary. And I've avoided writing about some potentially positive ones that deal with new treatments, because I think those new treatments are kind of piling up, and I feel like I should hold off until we at least get to a phase II trial and have some evidence that they work. Overall, I think ASH this year is positive for Follicular Lymphoma. I'm just searching for the right news to show that it's true.

So here's a bit of good news: It looks like Bendamustine + Rituxan (B-R), followed by Zevalin, is a really good combination.

Bendamustine is, of course, a chenotherapy that seems to match CHOP in effectiveness, but with fewer side effects. That's a pretty nice combination. It seems to have replaced CHOP as an initial treatment for a lot of oncologists.

Zevalin, on the other hand, despite its effectiveness, is not nearly as popular. A type of RIT (RadioImmunoTherapy), Zevalin delivers a dose of radiation directly to lymphoma cells, unlike traditional radiation therapy, which needs a non-moving target. Studies have shown Zevalin and other RITs to be very effective. However, in the U.S., there are issues that keep it from being used as often as it might be (the way doctors who administer it get paid; the complexity of delivering a radiation treatment -- issues that are related to efficiency, rather than effectiveness).

It's too bad RIT is not used more often, given its effectiveness. I keep looking for new research that might be the incentive to say, "Damn to efficiency issues -- let's use it!" Maybe we'll get lucky with this ASH research.

Researchers from the U.S. wanted to see how well Zevalin worked after B-R for Follicular Lymphoma. Previous studies have looked at Zevalin as a consolidation therapy after R-CHOP. (Consolidation therapy means it was given right after a frontline treatment: R-CHOP, then Zevalin to kind of clean up anything left over.) Given how effective B-R has been for Follicular Lymphoma, it seems worth trying Zevalin with it.

And it was indeed worth it.

B-R was given to 38 patients. 22 of them received a Complete Response. 15 had a partial response. That's a 97% Response Rate (37 out of 38). The other one had stable disease. Still pretty good. Bendamustine + Rituxan is pretty darn good on its own.

Of those 38 patients, 30 were able to receive Zevalin as consolidation. 25 of them finished with a Complete Response, and 4 remain in Partial Response. Of the 14 who stayed in the study who had a Partial Response after Bendamustine, 7 of them moved to a Complete Response immediately after Zevalin. Three more achieved a Complete Response within 16 months.

So the final tally: 83% of the patients achieved a Complete Response. 96% achieved either a Complete or Partial Response. And 71% who had a Partial Response after B-R achieved a Complete Response after Zevalin.

That's pretty dang good.

I think what really stands out for me is that these numbers are achieved with treatments that are already available. I know I've written before about how I think chemo is slowly on its way out, and maybe some day we can all deal with Follicular Lymphoma with easier targeted treatments that disrupt pathways and control the disease. But I've also said that there is a role for chemo, and this certainly shows that it's true. Until we have treatments like Inhibitors that have been proven to work, we have B-R and RIT.

And with numbers like these, it certainly seems like a combo worth considering.


Anonymous said...

Hi Bob,

I love you writings, big fan here. Certainly a strategy to keep in mind when treatment bekomen obvious. would you mind posting the link to that report? I would be interested to have some detail on the population in that study..



Lymphomaniac said...

Hi Ruup.
I can't believe I messed up and forgot the link. I'll add it to the post, and give it to you here as well:

There is some detail about the study population. I hope it's what you are looking for.

Anonymous said...

Thanks, I found what I was looking for: they were chemotherapy naïve FL (grade 1-2 and 3a) patients. I suppose that's relevant to keep in mind when looking at these great results. Again, thx. Looking forward to your next post!