Up with RIT

The good folks at The Oncologist, a journal for, well, oncologists, have devoted a whole bunch of space to lymphoma articles this month, particulalry on Radioimmunotherapy (RIT), like Zevalin and Bexxar. If you've been reading for a while, you don't need the full RIT explanation -- you know it involves full body radiation, that it's pretty darn effective, and that I'm a big fan.

Zevalin was recently approved as a first-line consolidation therapy -- that is, it can be used as an NHL patient's initial treatment, when following chemotherapy. These articles build on that use.

You can't see the whole articles without a subscription, but the article summaries look pretty interesting.

The first one is called "Harnessing the Energy: Development of Radioimmunotherapy for Patients with Non-Hodgkin's Lymphoma." The authors are calling for more use of RIT (in this case, Zevalin) -- always a good thing -- by recommending ways that it can be used most effectively on different types of NHL patients. "Fit" patients can handle aggressive chemo + RIT, with the possibility of curing the NHL. "Compromised" patients would also benefit from chemo + RIT, though with not quite as aggressive a treatment as with fit patients, since they can't physically handle it. "Frail" patients could use RIT alone (since the chemo might be too much for them), to control symptoms. I don't think the article is offering any new research, but it is getting into the different factors that an oncologist should consider before giving RIT. I think it's useful as another way of encouraging RIT to be used more widely.

A second article also looks at RIT favorably: "Rationale for Consolidation to Improve Progression-Free Survival in Patients with Non-Hodgkin's Lymphoma: A Review of the Evidence" says that too many NHL treatments do not achieve a complete response (that is, wipes out the disease entirely, rather than just reducing it, even if it's temporary). The authors look at a bunch of articles that have been previously published, and bring all of that separate evidence in one place. What they found is that RIT consolidation therapy -- that is, chemo followed by RIT -- results in more complete responses than other treatments. This seems to be true whether the RIT used is Zevalin or Bexxar, and whether it's an indolent NHL (like Follicular) or a more aggressive type. Once again, I see this as a giant pillow that is being swung at the heads of oncologists who are hesitant to use RIT ("Wake up! Wake up! Try this please!").

Yet one more. The authors of "Radioimmunotherapy for Stem Cell Transplantation in Non-Hodgkin's Lymphoma: In Pursuit of a Complete Response" are also pushing RIT as a chemo substitute, this time as a conditioner for Stem Cell Transplants (SCT). Right now, patients are "conditioned" with aggressive chemotherapy -- that is, before a transplant, their immune system is basically erased. It is then replaced with new, clean immune cells. The authors believe that RIT could be combined with chemo during that conditioning, and might be more appropriate for certain patients like the elderly or those who have had many chemo tretaments before their SCT. The authors say that there have been good results with RIT as a consolidation therapy (combined with a less aggressive chemo than is usually used for SCT conditioning), with auto SCT (using the patient's own cells) or reduced-intensity SCT ("mini SCT"), since the RIT helps make up for the less aggressive chemo.

Lots of initials on that last one, but the point is the same: RIT can and should be used in ways that it isn't being used for right now.

I think what's especially important is that The Oncologist calls itself "The International Journal for the Practicing Oncologist/Hematologist." In other words, it's read by the people who work directly with cancer patients to make decisions about treatment. The kind of "piling on" of articles might make some of them take notice and give RIT some new consideration.

I know Dr. R would consider it. We talked about RIT early on. Not a whole lot of it done at Yale, but they have a little experience with it, anyway.

Speaking of Dr. R, I see him Tuesday. Wish me luck. (Not that I'm anticipating any problems. But you just never know.)