Saturday, November 1, 2014

The "Fab Five" for Lymphoma

A few weeks ago, Medscape featured a video discussing some highlights from the 2014 Congress of the European Society for Medical Oncology (ESMO) in Madrid. The speaker is Dr. Martin Dreyling, professor of medicine at the University of Munich Hospital in Germany, and his focus is on recent developments in lymphoma.

The link will bring you to the video (it's about 12 minutes long) and a transcript (if you'd rather read his comments than watch).

In the video, Dr. Dreyling discusses the "Fab Five" (playing on the nickname for The Beatles, who were very popular in Germany before they came to the U.S.). But Dr. Dreyling is referring to the five compounds that are offering possible ways of avoiding chemotherapy for lymphoma patients (the unofficial theme of the ESMO conference). The Fab Five are: Bortezomib (Velcade), Ibrutinib, Idelalisib, Lenalidomide (Revlimid), and Temsirolimus (another kinase inhibitor, used for kidney cancer, now being tested for Mantle Cell Lymphoma). The Fabs, he says, "will help us."

Dr. Dreyling focuses on developments related to several specific lymphomas, including Follicular Lymphoma.He calls this section "Defying the Status Quo," by which he means moving beyond the current preferred approach in Europe, which is chemotherapy + Rituxan. Research shows that Follicular Lymphoma is sensitive to "targeted therapy," rather than the shotgun approach of chemotherapy. Idelalisib, for example, has been very effective (with over 50% response rates) for patients who have had chemo + Rituxan, but for whom that combination no longer works.

As an example of an approach that is used as a first-line treatment, he points to the RELEVANCE study, which involves Rituxan + Revlimid (R + R). The combination seems to work better than the two treatments given separately, and the RELEVANCE study involves over 1000 patients, very large even for a phase III trial. The response has been very good, and we'll know soon if it is as good, over time, as chemo + Rituxan.

The challenge for the next few years, as he sees it, will be to determine which of the Fabe Five compounds (and others like them) are working, but also what kind of markers will be found that will help identify which treatments will work best with which patients, and which will work best for all patients.

So while this wasn't a review of a lot of particular studies, I did find it valuable to see what is going on in Europe. I think they are dealing with a lot of the same challenges that we are dealing with in the U.S., and having some of the same successes.

And it's always fun to watch a lymphoma expert express optimism fore the future.


Anonymous said...

Thanks for the blog, I follow regularly. I'm in a similiar situation. Two interesting links maybe you'd like to blog about.

Sometimes it hard to seperate science from pseduo science, but I believe we should leave no unrealistic stone unturned.

Lymphomaniac said...

Thanks for the links. Interesting stuff. The Alfacalcidol link to lymphoma was popular a while ago, but then the research kind of died out. I'm not really sure why, but it never reached the level of a wide clinical trial. As for the increased fruit and veggie intake -- no arguments from anyone there. I thought it was interesting that the researchers could only speculate as to why survival was increased, whether there was a direct effect on the lymphoma, or an indirect effect by reducing co-morbidity, or death by something other than cancer (like a heart attack, made less likely by the better diet). Whatever the case, a healthier lifestyle is going to help us, no matter how it ends up working out.