Tuesday, October 6, 2015

Increasing Failure Free Survival in Follicular Lymphoma

I've been sitting on this for a couple of weeks now, but:
A presentation at the annual meeting of the Society of Hematological Oncology (SOHO) last month highlighted that treatments for Follicular Lymphoma seem to be improving Failure Free Survival rates. OncLive has a story.

OK, a couple of things before we move on. First, this is the first time I had heard of SOHO. I'm not an oncologist, but goodness knows I read enough about blood cancers, so I'm a little surprised I hadn't heard of SOHO before. Turns out the group was founded in 2012, so I feel a little better about that.

Second, I am less familiar with the term "Failure Free Survival" (FFS) than I am with other measurements for cancer treatments. I'm used to reading about Progression-Free Survival" (PFS), which I think is a more common measurement. Are FFS and PFS the same thing? I'm really not sure. They seem to be measuring the same general thing -- how long after treatment until the disease returns, but there are also some very subtle differences between similar ways of measuring how effective a treatment is, and I'm not prepared to say they are the same thing. I'm happy to hear from anyone who can explain the difference, if there is any.

So back to the article, and the SOHO presentation, which was delivered by Dr. Nathan Fowler from MD Anderson:
Despite an increase in Overall Survival for Follicular Lymphoma, there hasn't been a big change in Failure Free Survival. In other words, it's still about 5 years before the disease comes back, for most treatments.

According to Dr. Fowler, that might be changing, with newer treatments that target pathways instead of targeting the cells themselves. As we are learning more and more, killing off FL cells seems to depend not just on killing the cells themselves, but in messing with the processes that allow them to grow and survive -- the different "pathways" that they rely on.

Dr. Fowler discusses a few newer treatments, and the increases in Progression Free Survival that seem to be coming about.

For example, Ibrutinib is a BTK inhibitor. [I was going to describe how all of these treatments work, which I've done in the past, but I'm going to send you to Lymphomation.org instead. You can find descriptions on their Treatments pages, especially the page on Agents that Target Disease Pathways. They will do a more in-depth job than I can here.]

As Dr. Fowler points out, trials involving Ibrutinib have shown that different doses seem to have an effect on PFS. A phase III trial is underway that will compare B-R and R-CHOP with and without Ibrutinib. And finally, a trial was recently completed that looked at Ibrutinib + Rituxan as an initial treatment for FL. The results might be ready for ASH in December.

Dr. Fowler also discusses Idelalisib, Obinutuzumab, and R-Squared (Rituxan + Revlimid/Lenalidomide), all examples of newer pathway treatments. He brings up some interesting points about these newer treatments, such as the fact that they have fewer side effects than traditional chemotherapy, but those side effects can themselves be pretty severe.

Another interesting thing has to do with the whole PFS/measurement issue: some of the trials for these pathway targets show relatively low response rates, but that is because, ironically, the treatment is working well. In other words, only 25% of the people in a trial show a shrinkage in tumors, but many of the rest didn't have a shrinkage, but they didn't have growth, either -- they had stability, and that's not a bad thing (but it's also not the thing that's being measured).

So all in all, it's a nice overview of some the research that's being done on newer treatments, and a nice commentary on some of the things that make these newer treatments so different from what we're used to.

Plus, it already has me excited about the ASH conference, even though that's two months away.....

1 comment:

ilia segal said...

Hi Bob
I have to tell you how much i use your blog and how i wait for the next one and the next
For me your blog its the most balanced and best source of knowledge on FL. I am a 68 y. o. physician diagnosed with FL 8 month ago
I had Rituxan for starters and now only follow up

I am interested in your take on a very intriguing abstract # 1497 by Cabanillas at Al named clinically discordant indolent lymphomas - I think its a great paper - but may be too good to be true?
wishing you the best in your unbelievably important work for the FL community