Tuesday, November 15, 2016


More from the ASH abstracts.

This one has kind of a retro feel to it: "Sequential RCHOP, Radioimmunotherapy and Rituximab Maintenance Improves Early Outcomes in Advanced Stage Follicular Lymphoma: 5 Year Outcomes from SWOG 080."

This involves a Phase II clinical study involving 84 patients (at first) with stage 3 or 4 Follicular Lymphoma (or bulky stage 2), who have not yet had any treatment. Patients were first given six rounds of R-CHOP (Rituxan plus the chemo combo CHOP), then followed up with Zevalin (the RadioImmunoTherapy treatment), and then given Rituxan Maintenance for 4 years (once every 3 months).

Before I get to results, a couple of comments. As I said, this one has kind of a "retro feel" to it. Let me explain.

First, all of the big news these days focuses on treatments that are moving away from traditional chemotherapy like CHOP (and CHOP is about as traditional as it gets for Follicular Lymphoma). So it's interesting to see a successful trial involving chemo (and, as you'll see, it was successful). I've certainly expressed the opinion that CHOP trials are kind of outdated, and that resources could be better devoted to other things. But I've also said that CHOP still has a place in our bunch of treatments, and we certainly shouldn't get rid of it. (I'll say one or the other depending on my mood -- I'm fickle that way.) This trial also feels kind of retro because it involves RIT, which might be on its way out as an available treatment.

And finally, it feels kind of retro because I remember getting very excited, years ago, about a study that looked at R-CHOP and RIT (no maintenance) that was successful, and the researchers thought it was successful because the lymphoma was being attacked in 3 different ways. That combination approach always made sense to me -- cancer is too tricky to expect one treatment to wipe it out.

And this particular combination worked pretty dang well.

84 patients went through the R-CHOP and RIT. 59 of them had a Complete Response and 23 had a Partial Response, for an Overall Response Rate of 99%.

69 of those patients went through the last step and had Rituxan Maintenance, with 42 completing the full 4 years. The Overall Survival after 3 years is 96%, and after 5 years it's 94%.

Patients at various points in the trial experienced a variety of side effects, as they detail in the abstract. They had the most patients drop out of the trial during the Maintenance phase; they think 4 years is just too much time to be taking Rituxan.

But overall, those are some pretty good numbers. The researchers think this approach (RCHOP + RIT) could work well with "precision strategies" (which I assume are things like pathway inhibitors and immunotherapy), as a way of halting more high-risk lymphoma early on, with (I am guessing) those precision strategies to manage it from there.

So here's to retro treatments -- they still have a lot to offer us. Maybe this could be one of the many studies that show that RIT is worth saving?


Anonymous said...

At least according to the folks over at http://lymphomasurvival.com, R-CHOP remains the "gold standard" for treating "transformed" follicular lymphoma, which is always a risk for us follicular patients (I think something like 3% / year?), and is, as they describe it, a "potential barrier to otherwise long-term survival" with fNHL.

Perhaps things have started to change with CAR-T, where some transformed fNHL patients have already been successfully treated.

-- Ben

Anonymous said...

Anything that is cheap is what we are likely to use here in the UK.
Older drugs are cheaper, sorry more cost effective :-)