Thursday, June 9, 2016

ASCO: Velcade, Bendamustine, and Rituxan

Another good one from ASCO: "Effect of bortezomib on complete remission (CR) rate when added to bendamustine-rituximab (BR) in previously untreated high-risk (HR) follicular lymphoma (FL): A randomized phase II trial of the ECOG-ACRIN Cancer Research Group (E2408)."

I've written about combination therapies before -- the idea that one single treatment probably isn't going to cure Follicular Lymphoma (or most types of cancer). Cancer is a sneaky thing, always finding ways around our attempts to stop it. So combinations that attack the cancer in different ways might have a better chance of stopping it.

And this ASCO piece is about as combination-y as you can get. It's almost like the researchers looked at every FL treatment that has work in the last 5 years and tried to find a way to work it in. It's one big FL-killing stew.

Basically, they added Velcade (Bortezomib) to the already-successful combination of Bendamustine and Rituxan. Then, for good measure, they added Lenalidomide (Revlimid) to Ritixan Maintenance (making R-Squared Maintenance). Like I said -- if something has worked in the last few years, they threw it in there.

The study looked at 222 untreated FL patients who were considered "high risk," with a high FLIP score or high tumor burden. They were divided into 3 groups: one was given Bendamustine + Rituxan (BR) and then Rituxan Maintenance (RM). The second had BR + Velcade, and then RM. The third got BR + Velcade, and then RM + Revlimid.

The Overall Response Rate (complete or partial response) for BR was 90%, and for BR + Velcade, it was 91%. Pretty much the same.

But the Complete Response rates were very different: BR was 58%, but BR + Velcade was 74%. That's a pretty amazing difference.The researchers called it "significantly superior."

No word on how the Revlimid affected things, though the conclusion does say that more follow-up is needed to determine whether the Revlimid helps with prologing that CR.

So I'd call this good news. There were certainly some side effects (that's the problem with combining so many treatments -- you combine all of the bad stuff that goes with it, too. And there's always at least some bad stuff).

But a 74% CR rate says something about how well that combination is cutting off cancer's escape routes. This might not be THE combination we're looking for, but if nothing else, it gives us more evidence that the general strategy of combining treatments holds a lot of promise, and we're going to keep seeing more of it in the future.

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