ASCO Research

As promised, I wanted to review some of the Follicular NHL-related research from last week's ASCO conference. There are a few things creating some buzz around the web, plus a few things that aren't so buzzy, but that I found kind of interesting, given my own situation.

One of the less-buzzy things is a session called "Second-line therapy in follicular lymphoma in the United States: Report of NLCS observational study." Clicking on that link will take you to the ASCO web site and the official abstract or summary of the research. I'll try to interpret here, and say why I think it's important:

The NLCS is the National LymphoCare Study, a large project that looks back at the treatment history of a whole bunch of lymphoma patients. So the study isn't offering anything like new treatments; it's looking back at what has happened in the recent past and figuring out significant patterns. For this study, they wanted to see if there were trends for second-line therapies (what they call Rx2 in the abstract). We know that there is very little consensus now for first-line treatment. In other words, fNHL patients might get any one of about 5 or 6 treatments the first time they need treatment: maybe watch-and-wait; maybe straight Rituxan; maybe a chemo like R-CHOP, or R-CVP, or Fludarabine, or Bendamustine. Or maybe Bexxar or Zevalin. And that doesn't include the choices from clinical trials that haven't been approved yet.

But what happens when the inevitable relapse comes around? That's what the study looks at.

There were 2736 patientss enrolled in the study. 1841 were still being followed after just under 5 years. 991 of them had received a second round of treatment; about 850 of them had started that second round within a year (or less) after finishing the first round. [As a side note: this is good news for me. I'm on that group that's gone over a year. Knock on whatever piece of wood is nearby for me.]

Second-line treatments are still all over the place; like first-line, there's no consensus on what the best approach should be. (Which makes sense: having so many different first choices eliminates lots of second choices.) But, as they note, some interesting patterns were discovered.

1) Straight Rituxan is used more often as a second-line ttreatment than as a first-line treatment. I find that fascinating, given that I had Rituxan as my first-line. I think lots of oncologists (and no doubt lots of patients) want to hit the lymphoma hard the first time. That approach certainly has some merit. For me, management was key -- my lifestyle hadn't changed yet, and I was happy with that continuing. It's unclear whether Rituxan maintenance is included in this statistic, but that would certainly explain a lot.

2) Rituxan is used in combination with chemotherapy very frequently in second-line treatment. The authors seem to think this is surprising because if there is a short time before the second treatment, this would "represent rituximab resistance by common definitions." I'm no oncologist, but I don't think Rituxan in combination works that way. Failure of the chemo doesn't necessarily mean failure of the Rituxan, if it's job in the combo is to support the chemo, no replace it. Interesting trend, but an odd interpretation.

3) "Most pts remain anthracycline naïve": CHOP, which contains anthracycline, is being used less frequently in both first- and second-line treatments. Not surprising. And it will become even less common now that Bendamustine is getting NCCN recommendation as a first-line therapy (not that everyone listens to those recommendations, obviously). Anthracycline, with its potentially heart-damaging side effects, is going to be reserved for fNHL transformations. So sayeth I, the English teacher who reads a lot and makes good guesses.

The authors think this is all especially significant because it gives a better picture of what they may see when they recruit for clinical trials. In other words, they'll know they have a larger pool of people who, for example, haven't yet had CHOP.

I think it will have some significance, too, in the way oncologists consider certain  treatments. Maybe there will indeed be less CHOP and more straight Rituxan (or other monoclonal antibodies) as time goes on, as oncologists see that good results can be achieved.

For me, it's just nice to see what other people are doing, and how my own plans compare.

More ASCO analysis soon.