Saturday, January 7, 2017

What We've Learned About Maintenance

Following up on my last post, which looked at potential problems with toxicity in Bendamustine when combined with maintenance (either with Rituxan or Obinutuzumab, both of which are anti-CD20 monoclonal antibodies):

It's interesting that the GALLIUM study, which seemed to show that Obinutuzumab was superior to Rituxan in certain situations, also gave us some information about maintenance. The maintenance information was not the main focus of the study, but it came out afterwards when people who were at the session looked more closely at the data. (I don't want that to sound like the presenters were trying to hide anything, because they weren't; it just wasn't the main focus of the session.)

Interesting, too, that another session (which I wrote about here) had something similar happen. The focus of the study was on patients who had not yet been treated receiving R-CHOP, the RadioImmunoTherapy, and then 4 years of Rituxan Maintenance. Like the GALLIUM trial, this one had great results: a 99% Overall Response Rate, with 95% Overall Survival after 5 years.

But in a video describing the study, the lead researcher, Dr. Paul Barr, points out (very quickly at the end of the video) that "prolonged maintenance therapy" might not be good for the "elderly population" in the study. (The median age for the study was 52, with a range from 29 to 80 years old. I'm a few months away from 50, so I'm trying not to take that "elderly" comment too personally.....Really, the video was cut off right after that comment, so he might have gone on to explain that the long-term maintenance was a problem for the older patients in the study, not all of them. Again, I'm not saying he's trying to sneak something in there.)

When I say they're both "interesting," I mean that I find it fascinating that we got information about maintenance when that wasn't necessarily the main point of the study. Science works that way a lot -- you're looking for one thing, and you end up discovering something else. But I find it fascinating.

So what did we learn? Well, for me, we learned that maintenance isn't as easy to think about as we have been trying to think about it.

Whether or not maintenance is a good idea is one of those controversies in Follicular Lymphoma that seems really hard to answer. There have been lots of studies that have seem to say "Yes, it's a good idea," and then others that say the opposite -- and neither that comes up with the answer very strongly (it's always "Yes, kind of" or No, not really, but....").

And I don't think either of these studies gives an answer, either. If anything, it complicates the whole situation.

And you what? That's a good thing. And maybe exactly what we should have expected.

We've never had any easy answers when it comes to Follicular Lymphoma. So why should we expect this question to have one?

It seems like we're finding out that maintenance works sometimes, for some people, in some situations, for some circumstances. The same as pretty much any other treatment. But we're also finding out which times, people, situations, and circumstances it helps. And that's what's important. At some point, we're going to be able to figure out who a treatment is going to help before they start getting the treatment.

This is probably a good time to remind everyone that it's important to consider clinical trials when it comes time for treatment. The only way we can figure out who will be helped by treatments is to study them closely and carefully under rigorous conditions. And that means people need to sign up for trials. As always, has lots of information about clinical trials and how to find them.

1 comment:

Anonymous said...

Thanks Bob, The maintenance dilemma is such an interesting topic. I'm curious to know if some maintenance is better than no maintenance at all. I've seen some studies with 3-4 yrs maintenance after Chemo, or maintenance every 2 months..
I had R-maintenance every 3 months for 2 years after RCHOP and luckily, all went well, I had no side effects ( except a little fatigue on treatment day) and I am now in my 3rd yr remission. Am I just lucky or did I get just enough maintenance to help prolong remission without too much toxicity. I'd love to see a study where different maintenance regimes are compared to no maintenance at all. Not sure if that was already done. Thank you for all this helpful information! Hope you have a healthy 2017! Lilly