Yet More ASH Stuff

Two more press releases describing news coming out of this weekend's ASH conference.

The first is called "Fractionated 90Y-Ibritumomab Tiuxetan Effective as First-Line Therapy for Relapsed Follicular Lymphoma." 90Y-Ibritumomab is Zevalin, the RadioImmuno Therapy. The study showed that Zevalin was effective as a first-line treatment (that is, for Follicular NHL patients who not been treated before) -- as effective as chemotherapy. This is significant: Zevalin has already been approved as a second-line therapy, and then as a consolidation therapy (given immediately after chemo), but this is the first evidence that it is effective as a first treatment rather than some kind of follow-up. Furthermore, the study shows that Zevalin is effective for those with high tumor burden; previous research suggested that if the lymphoma was too far along, Zevalin wouldn't work.

The second study is called "Rituximab Dosing Schemes Prove Equal in Low-Burden FL."  This one, in some ways, contradicts a study that I commented on a couple of days ago. This one says that Rituxan maintenance (giving doses of Rituxan every 6 months) is as effective as giving Rituxan only when necessary. Both strategies delayed the need for chemotherapy for just under 4 years. The study, though, and its implications are a little more nuanced than a comparison to that other study would suggest. First, it is pointed out that the maintenance group spent a lot more money on treatment than the other one. Second, there doesn't seem to be any difference in quality of life or stress level in these patients; both knew that Rituxan was coming at some point. Finally, and maybe most importantly, it provides evidence that perhaps watch-and-wait is no longer necessary, since Rituxan in either approach (maintenance or as-needed) provides more time until chemotherapy is necessary than W & W does. (I tend to think, though, that there will be a big chunk of doctors who will think that no therapy is still preferable to any amount of Rituxan, unless and until it's necessary.)

As I said last time, none of these studies is The Big One, the answer to it all. In fact, it just kind of muddies things even more. But I tend to think that more options, even muddied options, is better than fewer. Arrows in the quiver -- until The Big One comes along, I'm happy to have more options.