Zevalin and Follicular Lymphoma

The Journal of Clinical Oncology published an article earlier this month on the effectiveness of Zevalin. The article is called, quite simply, "90Yttrium-Ibritumomab Tiuxetan Consolidation of First Remission in Advanced-Stage Follicular Non-Hodgkin Lymphoma: Updated Results After a Median Follow-Up of 7.3 Years From the International, Randomized, Phase III First-Line Indolent Trial." 


I'll translate: "Using Zevalin as an immediate follow-up to successful first treatment for Follicular Lymphoma Patients: We've been doing this for over 7 years and it's working, blah blah blah."

Some background, first, because I haven't really discussed Zevalin recently, and I apparently have a bunch of new readers.

Zevalin, along with Bexxar, are known as RadioImmunoTherapy treatments (RIT). RIT is a pretty successful way of battling Follicular Lymphoma. It basically uses Rituxan, which seeks out the CD20 antibody on FL cells and attaches itself to them. but what makes Zevalin (and Bexxar) different is that they add a tiny bit of radiation to each molecule of Rituxan. Traditional radiation doesn't usually work in FL, because the cells are traveling through the blood stream. Since Rituxan seeks out individual FL cells, it can deposit that bit of radiation on the cell. Healthy cells are more likely to be spared.

Early studies of Zevalin were extremely positive: very effective, with fewer of the side effects of traditional radiation (since it's targeted). The FDA approved it as a consolidation therapy -- basically, something that could be used immediately after another treatment to make sure all the FL cells got killed off. There was a lot of talk a few years ago, after the FDA approval, that a three-way treatment strategy might be the way to attack Follicular Lymphoma: a chemo/Rituxan cocktail, with a Zevalin chaser. Chemo, Rituxan, and Zevalin work in three different ways, so maybe that approach will finally be the thing that fools the FL cells?

There's been less talk of that lately, as traditional chemo seems to be dying off as a future focus. And Zevalin never really got the traction it should have gotten, given how successful it was in early trials. There are a few reasons for this, and they have nothing to do with its actual effectiveness. Zevalin can't be administered in an oncologist's office; it has to be done by a special team of nuclear medicine specialists, given that it is radioactive. Plus, there's some kind of Medicare-reimbursement issue that I don't fully understand that discourages doctors from using it. So, basically, there are monetary and political issues that keep it from being used, even though Zevalin is an effective treatment.

And the JOC study does confirm that Zevalin is effective. This article is actually one of the few long-term studies Zevalin. It looked at 409 patients with advanced Follicular Lymphoma who had a full- or partial-response to their first treatment. Half were given no treatment, and half were given Zevalin as a follow-up. The patients who got Zevalin fared much better. After 7.3 years, 41% of those patients had not had any additional growth in their cancer. Only 22% of the non-Zevalin patients had similar results.

If you don't want to wade through the original article, Cure Today has a nice summary.

I like to think that results like this will spark more of an interest in Zevalin, though I get less optimistic about it as time goes on. Which is a shame, because the idea that we are treating with such a different mechanism than other treatments is really attractive. Maybe, as combinations of newer treatments are being tried out, someone will decide to return to Zevalin as a consolidation treatment, and we'll see some great things happen.

In the meantime, it remains another arrow in the quiver, and we can never have too many of them.

First Choice for Follicular Lymphoma

I said I was going to write about Zevalin and RIT today, but I saw this and it was too important tpo pass up.

A few weeks ago, I wrote about an Italian study that suggested R-CHOP was the best choice for a first treatment of advanced Follicular Lymphoma. The problem was that this study only looked at R-CHOP versus R-CVP and R-FM, and other treatments (especially Bendamustine) have proven more effective with less toxicity. The study is certainly valid (and might mean the death of CVP), but isn't really timely.

So the question of which treatment is the best option for first-time Follicular Lymphoma patients remains open. Maybe R-CHOP won that three participant battle, but besides CHOP and Bendamustine, we also have watching and waiting, Our Old Pal Rituxan, and a host of other monoclonal antibodies, kinase inhibitors, and other stuff to choose from (now and in the near future).

The most recent Journal of Clinical Oncology has an editorial from Drs. Oliver Press and Maria Corinna Palanca-Wessels of Fred Hutchinson Cancer Center in Seattle, responding to the Italian study, called "Selection of First-Line Therapy for Advanced Follicular Lymphoma."

The authors agree that research has shown that, for advanced FL with symptoms, some combination of Rituxan and chemo is the way to go. (They leave aside the whole W & W issue, which is good -- they narrow things down to patients who clearly need some kind of treatment, though I would quibble that the W & W question isn't so clear cut in many oncologists' minds. Regardless, we continue....)


They review the Italian study, and point out some of its weakness, including its not paying attention to Overall Survival (that is, tracking whether patients died, no matter the cause), and focusing instead on Progression Free Survival. The lack of Overall Survival statistics make it harder to measure against other studies.


They also briefly mention the idea that more recent studies compare CHOP and Bendamustine, pointing out B-R's superiority.

So, the answer to the question of which is the best treatment for Follicular Lymphoma?

Sorry -- still up in the air. This article doesn't provide an answer for us.

And, frankly, I'm not sure we'll get one any time soon. But I think that's good news. We have so much in the pipeline that no one's going to want to say "Yes, this is it!" until we know that for sure. So I say take the bad news for the good news that it is: we don't have one single best option, we have a whole bunch of really good options.

Investing in Lymphoma

The Investing website The Motley Fool has been publishing a series on investing in companies that make treatments for cancer. One of them, published, last week, focuses onNon-Hodgkin's Lymphoma, including Follicular Lymphoma, and is called "Tackling Cancer: Non-Hodgkin Lymphoma's Biggest Current & Upcoming Players." NHL is the seventh article in the series, it being the seventh most commonly diagnosed cancer in the country. (The other six, in case you were wondering, are prostate, breast, lung, colorectal, melanoma, and bladder.)

It's an interesting piece, from an interesting perspective. A smart investor will want to back winners, and this is one way to think about which companies (and thus which treatments) are currently, and which are likely to be, successful.

First of all, I appreciate the description of NHL. Pretty basic, but it gets the facts right, including the fact that there are a whole bunch of different NHLs.The description of Rituxan, however, has a serious warning: "Rituxan can lead to very serious side effects." Since when? The whole reason Rituxan has been successful is that it has few side effects, especially when compared to traditional chemo.

Still, I like that the first choice for an investment is Roche and Biogen, makers of Rituxan. Seems pretty smart. It's a treatment that has changed Lymphoma survival for the better. There's a slight danger of buying high (since there are a whole bunch of monoclonal antibodies in development that could replace Rituxan, and Rituxan's patent is expiring soon). On the other hand, a whole bunch have already been tried, and they haven't proven to be much more effective than Rituxan, so who knows?

I love that the article also recommends Spectrum Pharmaceuticals (maker of Zevalin) and GlaxoSmithKlein, maker of Bexxar.  I'm a huge fan of RIT (RadioImmunoTherapy), and I wish it was used more. But it isn't. If I were giving investing advice, I'd rate these two a HOLD, but maybe some love from Wall Street will get them noticed and more people will use them.

(There's a long history of why oncologists don't recommend Zevalin more than they do, which I have written about before, though not for a while. Zevalin is actually back in the news. I'm working on a post -- maybe I'll revisit that history then. Look for it later this week.)

Finally, they recommend a couple of other companies, one of which makes a treatment for Hodgkin's, not NHL, and the other for a less common type of T-cell lymphoma. Sorry, I don't know much about either. Follicular Lymphoma is my focus.

Maybe even more interesting are the pipeline treatments that this writer is excited about: Ibrutinib, Epratuzumab, and Obinutuzumab (GA101), all of which are in trials for Follicular Lymphoma, as well as other types of NHL. These, to me, seem very promising. I won't get into why; I've written about all of them recently.

One final note. I have mixed feelings on an article like this. I don't really like the idea that my cancer is a vehicle for someone making money.

(Which isn't to say I am anti-capitalist. Far from it. I know the difference between a BUY and HOLD, for one thing. Also, I once bought $100 of stock in Ascent Entertainment Group, because they were rumored to be buying the Denver Nuggets and the Colorado Avalanche, and I wanted to be able to say that I owned 1/14,000,000th of a pro sports team. When they sold to Liberty Media, I made a handsome profit of $48.18, thank you very much.)

So, clearly, I'm not anti-capitalist. It just seems....distasteful.

On the other hand, if more investing means more money for research, I'm all for it.

So go nuts, Wall Street. Listen to what the Fool is saying.

Small Molecules for Follicular Lymphoma

A nice quickie for a Sunday morning.

Patient Power has another video follow-up from last month's 9th European Congress on Hematologic Malignancies in France. This one has the excellent title "Small Molecules Bring Hope for Follicular Lymphoma Patients." (You have to love anything that puts "hope" and "Follicular Lymphoma" in the same title.)

The three minute video is an interview with Dr. Gilles Salles of the University Hospital of Lyon in France. He mostly focuses on "small molecules" -- newer, often oral treatments that are targeted for FL cells. They are in their infancy, compared to something like Rituxan, so researchers are still playing with the most effective way to use them -- alone, in combination, as a maintenance strategy -- so we're going to see a lot about them as we move along.

I also like his last statement: we're so much farther along than we were 10 years ago, and we'll be so much farther still 10 years from now. Always nice to hear from a researcher.

Incidentally, if you haven't explored the Patient Power website, you should. Andrew Schorr, the co-founder and host, is a leukemia survivor himself, and an excellent patient advocate. 

(Also, just for kicks, I recommend you watch the video a second time. But this time, watch Dr. Salles lose focus halfway through it. He hears a bell, and then keeps looking to his left for the rest of the video. Imagine he saw an ice cream truck, and he's really hoping the interview will end soon so he can run and get a Toasted Almond bar, or the French equivalent, before the truck dives away. Fun with cancer!)

Spontaneous Remission in Follicular Lymphoma

I'm going to respond to a comment from Jeanne, who asked yesterday about instances of Follicular Lymphoma disappearing on its own. I started to respond to Jeanne in a comment, but then it got too long, so here it is.

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Let me start by reminding everyone that I am a Follicular Lymphoma patient. I was diagnosed in January 2008, watched and waited for two years, had 6 courses of Rituxan, and now, for over three years, I have been enjoying my partial remission. (The Rituxan knocked the FL back, but didn't get rid of it completely.)

I am NOT a cancer researcher, or scientist, or a medical doctor. The closest I come to being a doctor is that I was pre-med in college for a semester. (My kids like to remind me of this when I don't have an answer to a health question: "Weren't you a doctor for 10 minutes in the mid-eighties?" So much fun having wise ass teenagers in the house.)

If anything, I'm a Cancer Nerd. I read medical journal articles for fun, when they tell me something that might be useful. I don't know much about other types of cancer, even other types of lymphoma. I like doing all this reading and writing because knowing more makes me feel like I have just a little control. I like knowing what my doctor is saying to me, and I like being able to say, "Yeah, but what about this?" and forcing him to explain why his ideas are better. I do all of this because it gives me hope. And if it gives someone else hope, all the better.

So while I try to be as accurate as I can, you shouldn't take anything I say as medical advice. Ask your doctor about anything that seems interesting or worrisome.

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Now, there are instances of Follicular Lymphoma going away on its own. But, to throw some cold water on things right away: it also, more often than not, comes back.

The terms for this are "Spontaneous Regression" and "Spontaneous Remission."

Spontaneous Regression is more common. It involves things like lymph nodes getting smaller, without any kind of treatment. The common term for it is "waxing and waning": nodes get bigger, nodes get smaller, nodes get bigger again. It happens a lot. If a patient is watching and waiting, it's easy to get excited about. You're in that first few months, and you're feeling your nodes every day, still wondering if it was all a mistake, and you realize that maybe, just maybe, they're getting smaller. And you try to be realistic about it, but over a week or two, you are absolutely sure that the nodes are getting smaller. You go for a check up, and sure enough, the oncologist says they seem smaller, and your blood work looks better, too. And you start planning your call to the Vatican to report your miracle, and the onc tells you that it's normal. It's more than a little deflating.

(Even worse is the flip side: you feel them getting bigger, and you panic, and the onc tries to tell you not to worry, because your blood work still looks great.)

So there is some Spontaneous Regression: waxing and waning, where the nodes get smaller on their own, without any treatment. I don't think anyone has ever done any kind of rigorous study of this, but I think I've seen the number as 30% of FL patients will experience it.

Then there's Spontaneous Remission, where the disease goes away all on its own. It does happen. And, as I said, it more often than not comes back. But I've certainly heard of people who never had treatment, experienced Remission, and never had problems for many years. Rare, but possible.

Jeanne asked for a link, so I'll give this one: It's the Spontaneous Regressions page from Lymphomation.org, probably the best lymphoma patient site on the internet. It has lots of information, plus some links to medical journal articles, Which will excite you if you're a fellow Cancer Nerd.

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One more note about Remissions and Regressions: There are a lot of people online who push diets, supplements, or other natural/alternative treatments. They ate 12 pounds of broccoli a day and their Follicular Lymphoma went into remission. There's no way to tell if that one person's experience was because of the broccoli, or if it was just the natural course of their lymphoma, whether they ate 12 pounds of broccoli or 12 pounds of cookie dough every day. You never, ever see anyone online saying their cookie dough diet "cured" their cancer. Which is a shame. But it's worth pointing out that, if you search for "Spontaeous Remission," you're going to get links to a lot of these sites. My suggestion is to treat them skeptically. There's plenty of things that science can't tell us, but the hundreds of studies on R-CHOP can tell us something more than one person's experience with broccoli can tell us. I would love for someone to do a broccoli or cookie dough trial some day, but until that happens, I'm going to put my trust in science.

Hope all of this helps.

Follicular Lymphoma's Path

The journal Haematologica has put up online an article that will appear in print pretty soon. Its title is a pretty good indication of how think the actual text is:

"Somatic hypermutation analysis in follicular lymphoma provides evidence suggesting bidirectional cell migration between lymph node and bone marrow during disease progression and relapse."

It's  massive article: 22 pages of text, followed by another 49 pages of charts, tables, and figures. I'm not a scientist, so there's no way I'm wading through all of those figures, but I can certainly get the gist of it from the first 22 pages.

The researchers were interested in genealogical trees of Follicular Lymphoma cell clones. That is, they wanted to figure out where the first Follicular Lymphoma cell showed up in a patient, and after they divided, where they went from there. Early stage Follicular Lymphoma is typically present in lymph nodes, and later stage shows up in bone marrow (which is why most of us have gone through those nasty bone marrow biopsies -- to determine how far along we are with the disease).

What they found was that FL cells migrate fairly quickly from lymph nodes to bone marrow, and that, throughout the disease, the cells move between the two (with FL cells moving from the marrow to the nodes, too). The researchers looked at three FL patients during the study.

All of this is significant because it might provide some clue as to why Follicular Lymphoma is so difficult to wipe out entirely. We are learning more and more about the ways that cancer cells are affected by their "microenvironment" -- their immediate surroundings. Many researchers speculate that the microenvironment provides ways for cancer cells of many types to survive. For Follicular Lymphoma, the fact that FL cells move between lymph nodes and bone marrow indicates that they have different microenvironments that might affect them differently, allowing colonies of cells to survive and then grow again later on.

They call for more research on Follicular Lymphoma cells in the bone marrow, which certainly seems like a good idea.

Hard to know where this will take us, though I would speculate that it might have us re-evaluate what we believe about staging. (See the excellent Dr. Sharman's blog for a very recent discussion of staging and grading.) Right now, we treat all stages of Follicular Lymphoma as the same: because FL is systemic,that is, it can and often does exist in the same way all throughout the body, we can treat all four stages with the same treatments.

But this research seems to suggest that more advanced stages -- those that are present in the bone marrow -- might be a little different.

On the other hand, it also suggests that FL cells travel to the bone marrow pretty quickly, so maybe our staging is not as accurate as we think?

Hmmm. No real clear conclusions from this one. No one should go to their doctor and ask for a restaging or anything. But maybe this is another piece of the Big Puzzle?

R-CHOP for Follicular Lymphoma?

I guess you could label this one, "That's nice, but aren't you a little late?"

Italian researchers have completed a study on the best treatment for advanced Follicular Lymphoma. Results were published last month in the Journal of Clinical Oncology. Cure Today has a nice summary.

The results show that R-CHOP is the best choice, by several measures: Time to Treatment Failure and Progression-Free Survival, as well as the best Risk/Benefit ratio.

Here's the problem: in this study, R-CHOP was compared to R-CVP and R-FM (Fludarabine and Mitoxantrone). Not exactly cutting-edge treatments.

So, in a sense, kind of a useless study. R-CVP and Fludarabine are both certainly still used, though they are rapidly falling out of favor, with Bendamustine in the lead for our best Risk/Benefit choice, and a whole bunch of others -- non-chemotherapies -- close on its heals.

Which, in a way, makes the study very good news, too. It demonstrates just how quickly we're moving along. The lead researcher in the study admits that his results are already a little behind the times, as the Cure Today article says:

Dr. Federico agreed that bendamustine versus CHOP is now the central question. "Just (as) we solved the dilemma between R-CHOP and R-CVP, we are now (debating) the dilemma between R-CHOP and R-bendamustine," he said.

I remember, five years ago, soon after I was diagnosed, Dr. R saying Fludarabine was an option. No one really talks much about it now. Something that was more or less cutting edge just five years ago is more or less useless now.

Makes you wonder what things will look like in five more years, doesn't it? Bendamustine, a Cold War relic? Rituxan, like Al Gore, a shadow of the 90's? All those inhibitors, laughably out of date?

That would be pretty cool.

How to Know What to Say

I thought this was brilliant. So simple, but so brilliant.

I've written a lot about "what to Say/What Not to Say to Cancer Patients" posts. They come up a lot online. They don't usually say much that's new, but they come up a lot anyway, because it's such a raw subject for cancer patients. I think lots of us feel like writing about these experiences will help us work through some emotions.

The LA Times published a piece a few days ago on this topic, but with what I thought was a unique twist: it offered some advice not just on what to say, but also on who can say what to a cancer patient. It was prompted by an experience that one of the authors had with a colleague, who insisted that she come to visit the author after the author's breast cancer surgery. When the author declined, the colleague said, "This isn't just about you."

Of course, cancer isn't ever just about the patient -- it effects family, friends, work colleagues, etc. But, really, as we all know, it's mostly about the patient. We  the Cancerous should really be at the center of things.

And that's what the authors of this article do -- quite literally put the patient in the center of things.

The author with the needy colleague came up with what she calls "The Ring Theory." In their words, here's how it works:

Draw a circle. This is the center ring. In it, put the name of the person at the center of the current trauma. For Katie's aneurysm, that's Katie. Now draw a larger circle around the first one. In that ring put the name of the person next closest to the trauma. In the case of Katie's aneurysm, that was Katie's husband, Pat. Repeat the process as many times as you need to. In each larger ring put the next closest people. Parents and children before more distant relatives. Intimate friends in smaller rings, less intimate friends in larger ones. When you are done you have a Kvetching Order. One of Susan's patients found it useful to tape it to her refrigerator.

Here are the rules. The person in the center ring can say anything she wants to anyone, anywhere. She can kvetch and complain and whine and moan and curse the heavens and say, "Life is unfair" and "Why me?" That's the one payoff for being in the center ring.

Everyone else can say those things too, but only to people in larger rings.

When you are talking to a person in a ring smaller than yours, someone closer to the center of the crisis, the goal is to help. Listening is often more helpful than talking. But if you're going to open your mouth, ask yourself if what you are about to say is likely to provide comfort and support. If it isn't, don't say it. Don't, for example, give advice. People who are suffering from trauma don't need advice. They need comfort and support. So say, "I'm sorry" or "This must really be hard for you" or "Can I bring you a pot roast?" Don't say, "You should hear what happened to me" or "Here's what I would do if I were you." And don't say, "This is really bringing me down."

So simple, but so brilliant. And it can even go on the refrigerator.

As I've said, when discussing this topic, I always try to give people the benefit of the doubt in situations like this. I think people are basically good, and want to be helpful, but sometimes just don't know what to say or how to say it.

Wouldn't a nice schematic be really helpful?

Follicular Lymphoma: What's New

OncLive published a piece yesterday called "Numerous Drug Classes Studied for Use in Follicular Lymphoma." It's basically a summary of what Lymphoma Rock Star Dr. Bruce Cheson had to say at the International Congress on Hematologic Malignancies, which took place in February.

The article notes that there are no new chemotherapies under development for Follicular Lymphoma.

This is a good thing. A very good thing.

It means that researchers have pretty much abandoned the idea that shotgun approaches to treating cancer are no longer necessary. We know enough about the genetics of cancer that we can be more targeted in our approaches to finding and killing cancer cells. Unlike traditional chemo, these newer treatments don't kill as many healthy cells, so there is less toxicity and fewer side effects.

None of that is news, of course, to anyone who pays attention to these things. (Like me.)

But it is nice to have such a neat summary of all of the treatments that researchers are focusing on: according to the article, these include "monoclonal antibodies, signaling pathway targeting agents, apoptosis-inducing compounds, and immunomodulatory drugs."

Even better, some of the specific treatments are available in convenient chart form.

Some highlights (in my opinion):

• Rituxan will soon lose its patent protection. We'll see more anti-CD20 monoclonal antibodies soon. They won't necessarily be generic copies, but may be more effective than Rituxan. (Which will be hard to pull off. Most new monoclonal antibodies have roughly the same effectiveness.)
• Obinutuzumab (GA101) is showing mixed results. A lot hinges on the results of a trial that combines it with bendamustine.
• Ibrutinib is being tested in a phase 2 trial. So far, it had shown to be effective for up to 2 years in patients with Follicular Lymphoma that has returned after an initial treatment. The formal trial will give more information about effectiveness and toxicity.
• Idelalisib (GS- 1101), another kinase inhibitor, is also doing very well. One trial involving Idelalisib (GS- 1101) has it combined with either Rituxan, Bendamustine, or both, and is kicking butt no matter which combination is used. 
• Another trial combining Lenalidomide and Rituxan in untreated Follicular Lymphoma patients yielded a 98% response rate. Cheson called it "astounding," which seems like a pretty good word to use.

Cheson points out, too, that all of these great treatments will need to be tested, and so we'll need some folks who are willing to enroll in clinical trials.

Overall, some really excellent news in the piece, even if most of it is still stuff that's in the pipeline and not yet ready for use on everyday patients.

But we're getting there.

That quiver is filling up with arrows pretty quickly.

Ibrutinib in the News

The FDA has approved Breakthrough status for Ibrutinib for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL).

(Some consider CLL, a leukemia, and SLL, a lymphoma, to be different presentations of the same disease. I'll let the Lymphoma Research Foundation sort that one out for you.)

This expands the number of blood cancers that have received Breakthough status for Ibrutinib.

A couple of other links worth mentioning:

First, on Friday, Forbes.com ran a story on Ibrutinib called "The Wild Story Behind a Promising Experimental Cancer Drug." It is a pretty interesting story, as the author of the piece says: "an almost absurdly improbable story embracing the Human Genome Project on the one hand, and Scientology on the other."

It's not quite as sexy as that quote makes it sound. It being Forbes, it's heavy on the business end of how several drug companies were involved in bringing Ibrutinib to life. And it being written by a physician, it's also heavy on the medical terminology (though with some nice links to help explain things). But if you stick with it, it does give you a pretty good sense of just how complex the process is for creating a drug that might do some good for a lot of Lymphoma patients. And that unavoidably involves both science and business.

The other link comes from Dr. Sharman's excellent blog on CLL and NHL. He references the Forbes article (and is mentioned in it), and also suggests that, in his very informed opinion, we will likely see the FDA approve Ibrutinib for other diseases in the next three years. (He doesn't mention Follicular Lymphoma by name, but given some of the similarities between CLL and Follicular Lymphoma, that does seem likely (especially since there are several clinical trials already underway).

Sequestration

As long-time readers know, I don't really like to get political in Lympho Bob. Politics, especially these days, leaves little room for hope, and that's not really what I want to do here. I stay away unless there's something happening that directly affects cancer patients.

Enter the S-word.

The effects of the sequestration cuts are starting to come down now, and cancer patients are being affected.

There are reports of cancer patients being turned away from cancer clinics, because the sequester has resulted in cuts in Medicare -- like this one, which has been reported widely. Doctors in clinics are being forced to make choices between treating patients, firing staff, and considering alternate (cheaper, maybe less effective) treatments.

And cancer research will be hit hard, too, with cuts to the National Institutes for Health and the National Cancer Institute. We can expect some cancer trials to just stop in the middle of the study, since cuts will mean fewer patients enrolled, not enough to be statistically significant. Others will be slowed down. Cuts to the FDA will mean longer times to approval. It's possible that cancer research cuts will set things back for years.

There's certainly a case to be made for cutting spending. The problem is with the way the spending was cut -- with no discussion of impacts, no conversation about priorities, no talk about alternatives. It's the lack of conversation that hurts things, and we're in a time and place where there is no genuine conversation, no attempt to hear anyone else's point of view, no compromise.

And there's certainly still time to rethink cuts and make decisions about what's important. Cancer hots so many people, directly and indirectly, that I would hope everyone involved in these decisions will see how the sequester had impacted people they care about. More importantly, I would hope that they see the money that can be saved (if we have to be crass about it) in the future by spending some now to control, if not cure, so many cancers.

It's a very frustrating time to be a cancer patient....

Follicular Lymphoma Biomarkers

Well, I can only access the abstract for this article, but it reveals plenty.

It's called "Pre-specified Candidate Biomarkers Identify Follicular Lymphoma Patients who Achieved Longer Progression-free Survival with Bortezomib-Rituximab versus Rituximab," and it has just been posted to the website for the journal Clinical Cancer Research. 


The title pretty much sums it up.

A study involving 676 relapsed and refractory Follicular Lymphoma patients first determined which of the patients had a particular biomarker. In other words, their cancer cells had a feature that made them different. In this case, the biomarker is something called PSMB1 P11A C/G heterozygote. What is it? No idea. Doesn't matter if we know, as long as the French researchers know.

Basically, the 676 patients were divided into two groups, and half were given Rituxan, and the other half were given Rituxan plus Bortezomib, also known as Velcade, which is a proteasome inhibitor (it blocks an enzyme in cancer cells that keeps cancer cells from dying on their own). The researchers found that the patients who took the Bortezomib and Rituxan AND who had the biomarker had a longer time before the Follicular Lymphoma came back. The median was a little more than 14 months for those patients, versus about 9 months for those who took only Rituxan.

Now, 5 months isn't a really long time, but the bigger deal here is the identification of the biomarker. This is what the whole "personalized medicine" approach to cancer treatment is all about -- being able to look closely at an individual patient's cancer cells and find small biomarkers or other differences that can help us predict which treatments are more likely to work than others. Also, knowing what those biomarkers are might help researchers develop treatments that cam target cells with those specific biomarkers.

This is a Big Picture study, in my opinion. Nice results, but more importantly, a smaller step toward something big.

Bright Picture for Follicular Lymphoma

The good folks at Patient Power have  a new video interview on Follicular Lymphoma, with the very happy title, "Bright Picture for Patients with Follicular Lymphoma."

The video is a follow-up from the 9th European Congress on Hematological Malignancies in February, where, according to the video, Follicular Lymphoma was a big topic of discussion. No links to papers or abstracts, but their agenda shows some sessions on Follicular Lymphoma that cover the Big Issues: watch and wait, frontline treatments, how to treat at relapse, etc, etc. Basically, the same questions I've been reading about for 5 years -- the ones that we're still trying to answer.

So, while there don't seem to be any definitive answers coming out of the Congress, there are at least some hopeful developments. The video features an interview with Dr. Marinus van Oers from the Netherlands, who presented at the conference on "Optimal treatment for relapsing FL patient."

Dr. van Oers does indeed offer some hopeful information, including the results from a European study that showed that 20% of patients never needed any treatment after 16 years. That doesn't apply to me, of course, but it does validate the legitimacy of Watching and Waiting, something I do have an interest in (even if it's only to look back an reaffirm that I made the right decision 5+ years ago).

He also mentions that newer monoclonal antibodies, as well as other types of treatments, might very well help us do away with chemotherapy for Follicular lymphoma sometime in the (fairly near) future. "Small, smart molecules," as he says, will target cancer cells but leave healthy cells alone.


All in all, a brief video, but one worth watching, if only for the quick shot of hope it gives.