ASH: Enzastaurin

OK, back to some of the research coming out of ASH, which starts on December 8th.

It's interesting that I have seen so little hoopla about the conference. Usually, by this time about 10 drug companies have put out press releases announcing the results of their various trials.  Granted, it picks up once the conference starts, and the papers have actually been presented, so maybe we'll see more next week. But, on the other hand, I've also seen commentaries that say there isn't anything really groundbreaking to announce this year. So maybe that's what's going on. Most of what we're seeing is either backing up research that we already know about, or is the earlier stages of trials, so it's too soon to say the results are game-changers.

One of the latter type (too early to get excited) is a presentation on Enzastaurin; results from a phase II trial are being presented. Basically, this means it's a smaller-scale trial designed to show the treatment actually works, and the results would justify a larger, more expensive, time-intensive phase III trial.


Enzastaurin is a protein kinase inhibitor, which is a type of treatment that targets cancer cells by looking for something called Protein Kinase C Beta, which is present in B cells (the type of white blood cell that goes nutty in Follicular NHL). In solid tumors, C Beta seems to be responsible for allowing blood vessels to grow and feed the tumor (Enzastaurin has been used with brain cancer patients, for example). But it also seems to play a role in B cell lymphomas.

In this trial, 66 patients were given Enzastaurin. The main thing researchers were looking for was RR -- overall response rate. Basically, they wanted to see how many patients had some kind of positive reaction.

And the results look decent: 29.3% responded to treatment. A few are still taking Enzastaurin, three and a half years later.

More interesting, though, was that certain biomarkers seemed to correlate with better results. In other words, when researchers looked more closely at tissue samples, they saw that the patients with better results generally had certain features on their cells that didn't show up on the cells of patients that had no response. The results were significant enough that they will investigate further, but for now, the study was too small to say anything for sure. (That's why they have phase III trials.)

I found this interesting for two reasons. First, protein kinase inhibitors are pretty interesting. They can target cancer cells and leave normal cells alone -- certainly a trend in cancer research. But at the same time, the study shows how much more closely we're able to examine cancer cells genetic makeup and start making guesses as to why some treatments work for some patients, while others don't. Isn't your first reaction when you see that a treatment worked for 29.3% of people to ask, "What about the other 70%? Why didn't it work for them?" Well, we may know. That kind of personalization is becoming more and more popular.

It's not a significant study, in that it's not presenting any great breakthroughs, but for me, it emphasizes some of things that make me hopeful about fNHL research.