Rituxan, part 1

So let's talk Rituxan, since it's my new best friend and everything.


First, this is what Rituxan is NOT: a type of chemotherapy. It's not a chemical or a drug, but rather a monoclonal antibody (also known as a MAB).


To take a step back even further: Rituxin is not a natural antibody, but an artificial one. It's made from a combination of human and mice antibodies, which is why the side effects include an excessive desire for cheese and an unnatural fear of cats.

Seriously, though, there are some side effects, and tghey do come from the non-human origins. I'll get more into that another time.

Now antibodies, in general, are part of the immune system, and work by identifying and attaching to invaders (viruses, bacteria, whatever). The immune system is able to create an antibody for each different type of invader, and each one has a unique shape that will attach only to a certain type of invader. That's why we don't get sick from the same disease over and over again. For example, once you get chicken pox, the immune system develops a unique antibody for that invader; the next time you're exposed, the chicken pox antibodies recognize it, attack it, and wipe it out.

One of the "invaders" that the immune system recognizes is abnormal cells that we create. It happens -- something goes wrong with a skin cell, and before it can reproduce, the immune system says "Hold on -- you don't belong here," and takes care of it. Cancer cells -- tricky little devils that they are -- somehow get around that. There's lots of fascinating research as to why, but to keep it simple, let's just say that cancer cells pull some kind of voodoo stuff and say to the immune system, "No, no problem here, I might seem like an abnormal cell, but it's fine. Just ignore me." And the immune system, in its voodoo-induced zombie state, says, "Duh, OK," and leaves the cancer cells alone, allowing them to grow and do bad things.


Rituxin comes along, and when the cancer cells say, "No problem here, you don't need to worry about us," the Rituxin says, "I don't think so," and goes to work.


Unfortunately, the cancer cells end up winning after a while. For some reason, most people end up resistant to Rituxin -- it works for maybe a year or two, sometimes longer (especially with something called "Rituxin maintenance" where the patient gets more infusions a few months later), but eventually, the cancer cells figure out a way to work their voodoo magic on the Rituxan, too.


So why bother? If we know Rituxan is likely to fail, why not go to something else with better chances of lasting longer?


Well, let's think way back, almost two years ago, to when I started this blog. You will recall that I've been saying all along that Follicular NHL, while slow-growing, has a nasty habit of returning. As long as it stays slow-growing, it can be managed, something like a chronic illness. That means that for many people (probably most people) with fNHL, we plan all of this as a series of treatments, beginning with watching and waiting, then moving on to the treatment that will work best with the fewest side effects, and then trying more aggressive treatments as the need arises.

My plan had always been to try Rituxan first, and see how it goes from there. My reasons for doing so have to do with time. The more time we can hold off the fNHL, the more time there is for researchers to come up with something else that will work better. And, of course, the longer we can hold off before having to use CHOP, the better off we are should transformation take place, aqnd we have to deal with a lymphoma that has become more aggressive.


So maybe the Rituxan helps for a couple of years, and then the fNHL comes back. Well, there's CVP to try. Or maybe in those two years, there's a new treatment available -- maybe another antibody that targets a different protein on the nacer cell, or maybe a vaccine, or something else that's not as toxic as current chemotherapies.


Rituxan gives me some time.

So, the bottom line is this: Rituxan isn't going to cure me. If that possibility existed, I wouldn't have sat around for two years waiting. Ideally, it's going to buy me some time. There's also the possibility that it won't work at all -- that happens about 25% of the time. It's also possible that it won't wipe it completely, and that I'll have a Partial Response. But even that would be good news, given how slowly things have been growing.

The good news is: I still feel great. I ran again this morning, and I just finished playing The Eagles' "Best of my Love" on the guitar. I feel good about starting the treatment, and I feel confident that I'm going to have some success with it.

You all can take that positive energy from me and feel free to add to it.