Nice Follicular NHL Video

A very new, state-of-the-field video was just published on MedScape's web site. It's called "Assessing the Standard of Care for Indolent Non-Hodgkin Lymphoma, " and it features three top NHL researchers (James O. Armitage, Bruce D. Cheson, and Owen A. O'Connor) discussing where we are in terms of indolent (less-aggressive lymphomas like Follicular NHL).

(I've actually read stuff by Armitage, and recognize his name. When you have a favorite NHL researcher/author, I guess you know you're a lymphoma research nerd. I may write him a groupy-type e-mail and ask if he'll be my Facebook friend.)

Anyway, the video is about 30 minutes long, and the link for it is here. MedScape may ask you to create a free user name and password. If you have more usernames and passwords out there on the internet than you'd like (and I sure do), then you can type medscape.com/viewarticle/586053 as a Google search term, and Google will give you a direct link to the video without your having to sign in. (Sneaky stuff.)

I'll give you some highlights, in case you want to skip the video, or in case you think a little previewing will help you follow what they're saying.

The first section of the video discusses current diagnosis and treatments for fNHL and SLL/CLL (another indolent lymphoma). No surprises here -- you need a biopsy of a lymph node to really know what you're dealing with. As they bring up, there's still some discussion in the NHL community about the most effective treatment options. I know from my own research that a lot of the problem has come from there being a lack of willingness to be a part of clinical trials, though that's changing. The three researchers discuss Watch and Wait for a fairly significant chunk of time, and all seem to agree that for someone who is asymptomatic with low tumor burden, it's an appropriate strategy, given that things can stay stable for years. Like any treatment option, it can be misused, and some doctors seem to let the watching go on for too long before more active treatment (not a problem for me -- I keep Dr. R on his toes).

After W & W, common treatments are usually straight Rituxin, or Rituxin with some combo chemo, such a R-CVP or R-CHOP, which are nearly the same chemo cocktail but with CHOP having one more drug added to it. (I've discussed this before.) The decision to choose CVP over CHOP has to do with the likelihood of transformation to a more aggressive form of NHL; CHOP is used if the disease becomes more aggressive, or is reserved for later use if the chance for transformation is likely. Other chemos like Fludurabine are mentioned, as are RadioImmunoTherapies like Zevalin.

There's also some discussion on the video about stage 3 fNHL and its implications. Some think all stage 3 fNHL should be treated as an aggressive lymphoma; others divide stage 3 into 3a (less aggressive) and 3b (more aggressive), treating 3a the same as a stage 1 or 2, using strategies like Watch and Wait.

What all of that means for me is that I've been evaluated as stage 3a (with one node area pretty active, and several others (as the lymphoma specialist as Yale said) barely lighting up the screen). The plan that Dr. R and I have in place is very much in line with what the state-of-the-field seems to be saying. Very comforting.

The video then discusses some future treatments. If you've been keeping up with all of the research I've been writing about in the blog (without your eyes glazing over), then the video will give you a nice summary. Much of the new research has been on monoclonal antibodies that will either improve upon or combine with Rituxin. There are several of these antibodies now in development or in various stages of clinical trial. Other research is being done on ImmunoModulatory agents: rather than attacking the tumor cells themselves, they attack their environment and affect how the tumor cells interact with that environment, disrupting the tumor cells' work.

The researchers also discuss what they think treatments will look like 5 years from now. They all agree that research is moving in the direction of "personalizing" teatments. This isn't to say every patient will get a different treatment, but rather they will be able to know enough about how each individual patient's tumor cells and their environments will likely respond to certain antibodies or other treatments. So rather than using an "average effectiveness (more people respond to X than Y, so we'll try X)" standard, or broad-acting chemo, they'll have better reasons for choosing certain treatments over others. The idea is to maximize efficiency and minimize toxicity.

Very interesting stuff, and very hopeful. I quoted someone from the support group once, whose doctor told her "If we can keep a patient alive for 5 years, we can keep him alive for 50." That certainly seems to be the attitude that these researchers are taking. Maybe it won't be 5 years before we know how to effectively personalize treatment -- maybe it will be 10 -- but there are certainly enough options out there to treat people until researchers can figure that out.

Hope you enjoy the video. (Or skip it, since it probably took you a half hour to read my summary anyway.)