Treatments in the News

First, a musical update:
On Saturday, Peter played alto sax at the FMI All-State Band concert. This involved over 300 kids from Catholic schools around the state. Four bands played; Peter had auditioned and was placed in Symphonic Band, second highest of the four. He did a great job. It's rare for a fifth grader to make that band, so we're very proud of him.

The kids got their scores from the Connecticut Young Musicians Festival, where they all played piano. All three of them scored a 4 out of 5, so all of us are pleased. Catherine has been playing less than a year, so that score was great. And John and Peter both played some challenging pieces, so their scores were great, too.

Such talented children. I can't even read music, so I can take no credit for all of this.

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I listened to a really interesting webcast on follicular NHL yesterday, with a doctor from Rochester, NY who is a specialist in this lymphoma. [I can't get the link to work, so I can't let you listen to it.]

He talks about some of the promising treatments for follicular NHL. Thought I'd share some of what he said:

The standard treatment for a long time was a chemotherapy called CHOP, which stands for four different drugs. In the last 10 years, it has been CHOP-R, which is CHOP plus Rituxin, a monoclonal antibody which works by seeking out a specific protein (CD20) that is present on the B-cells that are affected by certain lymphomas. Rituxin is also used on its own with some effectiveness. One of the great things about Rituxin is that is has almost none of the side effects that chemo has. This drug alone has almost doubled the survival rates for fNHL patients.

Rituxin has been used for about 10 years, and in that time, researchers have built on this technology in other ways. Two other drugs called Bexxar and Zevalin also target CD20 proteins. But the twist is that they have a tiny dose of radiation, so they zap the B-cells when they find them. This is a huge advance. Traditional radiation treatment targets individual tumors. Lymphomas are harder to use radiation on because the "tumors" are cells that travel through the blood -- nearly impossible to pin down. Bexxar and Zevalin allow the radiation to get to where they need to go. The treatmnent takes only a week (versus months for chemo). The downside is that, because it's radioactive, a special team needs to be assembled to administer it. No going to the office and letting an onc nurse do it. So they've been underutilized so far. Yale, however, has offered the treatment in the past.

Another drug being tested now is called Revlimid. It has been approved for use on patients with Multiple Myeloma, another blood cancer, a "first cousin" of follicular NHL. This one works in a different way than the monoclonal antibodies. There is some research that suggsts that certain abnormalities of the blood vessels may support cancer, a possible reason Multiple Myeloma (and perhaps indolent lymphomas like follicular) are so hard to wipe out. Revlimid targets the blood vessels, creating changes in them that may wipe out whatever property is getting in the way of killing off cancers.

Another Myeloma drug being tested on fNHL patients is Velcade. This takes yet another approach to the disease. It is a Proteozome inhibitor. As the webcast describes it, every cell has a "wastebasket" that collects waste products that occur when a cell takes in nourishment; the wastebasket is then emptied into the blood, where it gets expelled. Velcade shuts off the "emptying" feature of the wastebasket. All of the waste builds up in the cancer cell, and it eventually kills itself. It's kind of a poison that is already present in the cell.

Yet another group of drugs in development is called BCL2 inhibitors. BCL2 is a protein that keeps a cell from dying. When the cell runs out of the protein, it dies -- this is a normal thing. All cells die. In lymphoma cells, particularly in indolent lymphomas like follicular, there's too much BCL2, so the cell takes a long, long time to die (and it's really hard to kill off). The BCL2 inhibitor would tell the lymphoma cells to stop producing so much of the stuff, so they would either die a "normal" death, or be easier to kill off with Rituxin or some other agent. These drugs are in early trials, so probably 4 or 5 years away from approval. But this is most promising, if it all holds up as well as it has so far in early tests. The really cool part of this? It's a daily pill -- no chemo, no injections.

That's kind of the theme in lots of these potential treatments: unlike chemo and radiation, there are fewer, less harsh side effects. And more importantly, more options. Follicular NHL, as I've written once before, is the "Tarzan" cancer -- there are always more vines to grab on to, more treatments to try. Some treatments work for some people; other people won't stay in remission and need to try something else. But it usually grows so slowly, there's time to try other things.

The researcher being interviewed was very excited about it all, and I'm excited about it all, too. It's bringing out that inner scientist in me. Makes me wish I stayed pre-med for more than one semster....