Here's a link to an interesting slide show from Michele Ghielmini, from the Oncology Institute of Southern Switzerland, called "Update on Lymphoma and Myeloma 2011." I don't know much about Ghielmini, and I'm not sure why this slideshow is being posted, though there's an ad on the last slide for a European lymphoma conference in June, so I'm assuming that Ghielmini is presenting this slideshow there. The slides are organized around a series of "burning questions" that are being deabted and researched right now, with one question focusing on each of several different lymphomas/blood malignancies.
I found the burning question for Follicular NHL especially interesting: Watch and Wait or R-CHOP?
The slides present a bunch of information, and I assume Ghielmini will explain and comment on them during the conference, but my first reaction to that question was, "THOSE are my ONLY two choices?"
Looking at the slides, I think this is kind of a false question, and I'm guessing Ghielmini doesn't mean to answer it, exactly, at least as it is presented. The slides actually discuss a whole lot of fNHL research from the last few years, comparing, in various combinations, W & W, single agent Rituxan, R-CHOP, Bendamustine/Treanda, and a few other established and newer treatments. The second-to-last slide for the Follicular section (slide #31) clearly shows that Bendamustine is a superior choice, if you're looking only at statistics. That wasn't even included in the burning question.
It's the last slide in the section (#32) that brings it all together. So I'm guessing the answer to the burning question of "Watch and Wait or R-CHOP?" is probably something like "Neither. Or either. Or both. Or something else." In other words, if I was someone looking for a definite answer as to what the ideal first-line treatment should be, I'm not going to find the answer in this slide show.
The final slide says to consider prognosis (grade, stage, and FLIPI score), factor in symptoms (none to life-threatening) and weigh the patient's priority (long remission vs management of symptoms) and then consider Watching and waiting, a "soft" treatment like Rituxan, RIT, or Treanda, or an "intensive" treatment (like CVP or CHOP).
So, it's an interesting slide show, but in the end, we're really no closer to figuring out the best course of action. (In fact, the last slide is dated 2009. Nothing much has changed in two years.) As the last slide suggests, it really is an individual choice at this point in the evolution of fNHL treatment.
The potential good news in all of this is that there are a lot more treatments that are likely to become available in in the next 5 years. The potential bad news is that maybe none of them are going to be the answer to this burning question. But then, the good news is, that means more potential treatments than we have now, which is good when you consider that the dominent strategy now in dealing with Follicular NHL seems to be to keep looking toward the next treatment while hoping the last one keeps working. More arrows in the quiver, as Dr. C, the specialist I saw so long ago, would say.
Still lots of reason for hope.
I found the burning question for Follicular NHL especially interesting: Watch and Wait or R-CHOP?
The slides present a bunch of information, and I assume Ghielmini will explain and comment on them during the conference, but my first reaction to that question was, "THOSE are my ONLY two choices?"
Looking at the slides, I think this is kind of a false question, and I'm guessing Ghielmini doesn't mean to answer it, exactly, at least as it is presented. The slides actually discuss a whole lot of fNHL research from the last few years, comparing, in various combinations, W & W, single agent Rituxan, R-CHOP, Bendamustine/Treanda, and a few other established and newer treatments. The second-to-last slide for the Follicular section (slide #31) clearly shows that Bendamustine is a superior choice, if you're looking only at statistics. That wasn't even included in the burning question.
It's the last slide in the section (#32) that brings it all together. So I'm guessing the answer to the burning question of "Watch and Wait or R-CHOP?" is probably something like "Neither. Or either. Or both. Or something else." In other words, if I was someone looking for a definite answer as to what the ideal first-line treatment should be, I'm not going to find the answer in this slide show.
The final slide says to consider prognosis (grade, stage, and FLIPI score), factor in symptoms (none to life-threatening) and weigh the patient's priority (long remission vs management of symptoms) and then consider Watching and waiting, a "soft" treatment like Rituxan, RIT, or Treanda, or an "intensive" treatment (like CVP or CHOP).
So, it's an interesting slide show, but in the end, we're really no closer to figuring out the best course of action. (In fact, the last slide is dated 2009. Nothing much has changed in two years.) As the last slide suggests, it really is an individual choice at this point in the evolution of fNHL treatment.
The potential good news in all of this is that there are a lot more treatments that are likely to become available in in the next 5 years. The potential bad news is that maybe none of them are going to be the answer to this burning question. But then, the good news is, that means more potential treatments than we have now, which is good when you consider that the dominent strategy now in dealing with Follicular NHL seems to be to keep looking toward the next treatment while hoping the last one keeps working. More arrows in the quiver, as Dr. C, the specialist I saw so long ago, would say.
Still lots of reason for hope.
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