ASH: R squared

Two presentations at the ASH conference will focus on the "R squared" regimen, so called because it features a combination of our old pal Rituxan with Revlimid, also known as lenalidomide. If there is anything approaching excitement about a Follicular treatment at ASH, it's probably this combination. (Though the excitement is muted becuase these are phase II trials being discussed.)

Lenalidomide is currently used to treat multiple myeloma, another blood cancer. It works (we think -- we're not entirely sure) by boosting the immune system and by cutting off some of the processes that cancer cells need to grow. It's all kind of murky, but it works.

The first study, by researchers at M. D. Anderson, looks at untreated fNHL patients (and a couple of other types of indolent lymphoma). Results were very positive. Of the 103 patients in the trial, 90% achieved some kind of response. Results for the 46 Follicular patients were outstanding: 98% achieved a response, with 87% achieving a complete response. After 2 years, 89% of Follicular patients were still cancer free. That deserves some kind of "Wowwee" comment.

A new trial comparing R squared with more traditional chemo is underway as we speak.

The second study, by some Italian researchers, looked at R squared in patients who had between 2 and 4 previous treatments that contained Rituxan. As great as the first study seemed to be for untreated patients, this would provide answers for others patients. It's possible, for example, that patients in this study might have become resistant to Rituxan, and so their reactions to lenalidomide would be different. This study also looked at indolent lymphoma patients EXCLUDING Follicular. Not sure why they ruled out fNHL, but I was curious about the results anyway.

Of the 39 patients enrolled, 52% achieved a response of some kind. Not as good as the response in untreated patients, but still pretty good. As the researchers point out, that response rate puts them pretty well in line with other R + chemo combinations, but with fewer side effects. The results are good enough to warrant a larger, phase III study.

There are a few people in the support group who have been on lenalidomide, mostly as a single agent, from what I remember, and the results have been decent. It will be nice to see some larger trials, with the treatment closer to approval, to really give us something to be excited about.

But this is a pretty good start.