ASCO: Follicular Treatment Options

And so it begins: the abstracts and press releases for papers at the upcoming ASCO conference. ASCO is the American Society of Clinical Oncology, and their annual conference takes place in Chicago June 1-4. There are a whole bunch of lymphoma-related conferences throughout the year, but one reason I like ASCO so much is that it's devoted to clinical oncology -- the doctors who work directly with patients. All lymphoma research is valuable; there's no question about that. But the clinical stuff appeals to my pragmatic nature.

I'll try to review as many of the Follicular NHL abstracts as possible over the next few weeks. This first one is from a group of researchers in Italy. Their aim was to try to establish a standard for treating advanced fNHL. This represents a serious problem: there are lots of treatments available, but no real agreement over which one should be used, or which should be preferred, or in which order they should be given.

The presentation is called "R-CVP versus R-CHOP versus R-FM as first-line therapy for advanced-stage follicular lymphoma: Final results of FOLL05 trial from the Fondazione Italiana Linfomi (FIL)," and, as the named implies, they attempted to compare three widely-used treatments: CHOP, CVP, and Fludarabine (with Rituxan added to all of them). The study took place over 5 years, and involved 504 patients, divided between the three treatments. The patients were measured for Time to Treatment Failure (evidence that the treatment didn't work, or evidence that the disease had returned or gotten worse).


Overall, 91% of patients responded to the treatment they were given. (Which is very good -- and further evidence of why it's so hard to establish one treatment as the best). After 3 years, Time to treatment Failure (that is, the percentage of patients who had no progression) for the three treatments were 46% for R-CVP, 64% for R-CHOP, and 61% for R-FM. But while CVP seemed less effective than the others, R-FM also resulted in a greater number of secondary cancers (probably leukemias, from what I've read of Fludarabine when Dr. R mentioned it to me as a possibility long ago).

That would seem to make CHOP the winner, but, interestingly, the abstract does not some right out and say so.

My guess, then, is that clinicians will continue to choose whichever of the three has been most appealing to them up until now.

Of course, the study didn't include Bendamustine, which might have come out as successful as CHOP, but with less toxicity. Which doesn't do anything to clear things up.

Two ways to look at this: 1) There's still lots of confusion, and no one knows what the best thing to do is. Or 2) We have lots of options, and they all seem very good, so if one doesn't work, we can try another.

I choose the latter.