No More Chemo?

Time Magazine has a piece in this week's issue called "No More Chemo: Doctors Say It's Not So Far-Fetched." The focus is on targeted, molecular-based therapies, and the job they do of focusing on cancer cells instead of healthy cells. If you've been keeping up with things, none of this is news. Still, it's about as good an introduction to the current and future state of cancer treatment as you'll find online.

The article was prompted by another Time article from the week before, "New Drug May Be Best Treatment for Leukemia Yet," which focused on the use of Ibrutinib. This earlier article looks at a New England Journal of Medicine piece that reported on Ibrutinib's success with Chronic Lymphocytic Leukemia (CLL), a slower-growing version on leukemia. Of course, Ibrutinib is also being tested in a bunch of other blood cancers, including Follicular Lymphoma.

The more recent article focuses on cancer in general, and the ways shotgun-style approaches to treatment are on their way out (though certainly still around -- just not necessarily as a first option anymore).

I like the way Dr. George Demetri from Dana-Farber put it: "The field is moving toward using the right drugs at the right time in the right patients."

As I said, nothing earth-shattering of you've been following cancer developments, but it's a good introduction to pass on to anyone who hasn't been.

Follicular Lymphoma Survival Statistics

The medical journal Blood, which focuses on, well, blood, has in its most recent issue an article called "Improvements in Observed and Relative Survival in Follicular Grade 1-2 Lymphoma over Four Decades: The Stanford University Experience." As the title implies, the study looks at survival statistics for Follicular Lymphoma patients at Stanford from 40 or so years, trying to determine what kind of progress we've made.

Apparently, we've made a bunch.

The study looked at four different time periods (or eras) of treatment of Follicular Lymphoma patients, tracking patients from each period, and comparing them.

Era 1 is the "Pre-anthracycline" Era, from 1960 to 1975. They looked at 180 patients from this period. Anthracycline is a powerful category of chemotherapy drugs that do a great job, but also cause some heart damage. For Follicular Lymphoma, CHOP is the most commonly used anthracycline-based treatment; specifically, it's the H in CHOP -- Hydroxydaunorubicin (Adriamycin). So Era 1 represents those years before we had CHOP, basically.

Era 2 is the "Anthracycline," Era, from 1976 to1986, when these treatments were most popular. They looked at 426 patients from this era.

Era 3, is the "Aggressive Chemotherapy/Purine Analogs" Era, from 1987 to 1996. They looked at 471 patients from these years. This era saw the popularity of Purine Analogues like Fludarabine. Really interesting concept: purine analogues mimic "purines," which is a substance that, among other things, makes up part of our DNA. So when a cancer cell divides, Fludarabine sneaks in and takes the place of a purine in the DNA, preventing the DNA from recombining and making a new cell. Unfortunately, Purine Analogues leave some nasty side effects: higher risk of infections, for example. And of developing leukemia.

Finally, there's Era 4, the "Rituximab" Era, from 1997 to 2003 (and, arguably, up to today, though that's changing pretty rapidly). They looked at 257 patients from this era.

In some ways, the different eras aren't all that significant, though I think that look at our treatment history is kind of fascinating.


Here's the important stuff:

Median Overall Survival (that is, death from any cause, not from FL specifically) was about 11 years in eras 1 and 2.  But it jumped to 18.4 years in era 3. As for era 4?  A median still hasn't been reached. Too many people still alive. That's a good thing. I think we can assume it will be higher than 18.4 years.

If you look at the Wikipedia page for Follicular Lymphoma, the prognosis section says that the median Overall Survival is about 10 years. I'm not going to link to it. It will only upset you. It certainly upset me when I was first diagnosed, and it upset a lot of my loved ones, to (because that's what we do when we don't understand something -- we Google it, and a Wikipedia entry is inevitably near the top of the results).

Ten years, especially to a 40 year old with 3 kids, is nothing. But 19 years (we're rounding up because we're optimistic)? That's a whole lot of time. Especially when you consider how rapidly we're progressing with treatments. Heck, we're probably on Era 6 by now.

I've said plenty of times that I avoid numbers, but I break that rule when the numbers are good.

And these are good.

Follicular Lymphoma: Revlimid + Rituxan

Lots of reports in the last few days about a successful phase 2 trial that looked at Rituxan and Revlimid (sometimes known as R + R) in previously untreated Follicular Lymphoma patients. The results look very promising.

There's no need, I assume, to introduce about Our Old Pal Rituxan. I've written about Revlimid before, but it's worth a reminder:

Revlimid (also known as Lenalidomide) is kind of cool -- it works in a bunch of different ways, so it can potentially be used for lots of different cancers, both liquid and solid. It works, for example, by messing with cancer cells' ability to grow by keeping stromal cells from growing in the bone marrow. These cells are necessary for the cancer cells to grow -- no stromal, no cancer. It can also inhibit new blood vessels from growing, which cuts off a source of food for cancer cells.

This is a treatment with lots of potential.

And apparently, when combined with Rituxan, that potential is reached even more. The study looked at 54 patients (a pretty small sample, but it is a phase 2 study, after all), and a whopping 92.6% (50 out of 54) had a response to the treatment. 72% achieved a complete response.

Those are pretty darn good numbers. Absolutely worth making this a larger phase 3 trial.

In other news from the same company, Revlimid was combined with R-CHOP for patients with Diffuse Large B Cell Lymphoma (a more aggressive type). Similarly excellent results: 98% response rate, with 74% achieving a complete response.  It's not Follicular Lymphoma, but I always like to keep an eye out for anything that can help with transformed FL.....

Read about the two studies in stories from Benzinga and PharmaTimes Online.

Good stuff.

Education of a Cancer Nurse

I read an excerpt today from a new book called I Wasn't Strong Like This When I Started Out: True Stories of Becoming a Nurse, by Laura DeVaney, a four-year head-and-neck cancer nurse. The excerpt is, as one 20-year nurse says in the comments, "one of the most honest portrayals of nursing I've read."

So be warned -- it's a little bit graphic. Know that before you click.

But it did remind me of how great most of the oncology nurses I know have been. They're compassionate, but realistic. That's just what I want in my cancer nurse.

I've always wondered just what makes someone go into oncology nursing. I don't think this excerpt really answers that question. I'm sure it's different for everyone, but I suspect they've been touched by cancer, and want to do their best to make it go away -- or make it go a little easier, because they know what it's like.

I had a student once who was studying nursing. She was great -- smart, articulate, worked very well with other students in the class. I thought she'd make a great oncology nurse. On the last day of class, I asked her what kind of nursing she wanted to go into.

"Well," she said, "I really hate being around sick people. So, probably dermatology. Or plastic surgery."

I was disappointed -- I'll be honest. It certainly wasn't the first time. I have lots of students who want to be nurses. A great many of them don't seem to care about anything -- studying, other people, whatever -- and I really want to tell them, "You know, I deal with a lot of nurses. I wouldn't want you to be my nurse."

That's not really fair to them. Just like it wasn't fair of me to think my student should go into oncology, rather than plastic surgery.

After all, how many people can really handle cancer? Heck, even I don't want to spend too much time in my oncologist's office.

So consider this a loving tribute to all of those oncology nurses who do so much for us. Even those who aren't so nice sometimes.

Follicular Lymphoma: Idelalisib

Kind of a quicky, because I'm busy with work:

A phase 2 study of  Idelalisib (formerly known as GS-1101) shows good results in patients of Follicular Lymphoma and other indolent (slow-growing) lymphomas.

The trial looked at 125 patients, focusing particularly on those who refractory to Rituxan and certain chemos. Those enrolled had a median of 4 previous treatments. (Basically, these are folks who are starting to notice the quiver is getting a little light on arrows, if I can use a comparison I'm fond of.) This is a fairly under-represented group, so it's nice to a see a trial that focuses on them.

Idelalisib is another kinase inhibitor --one of those newer treatments that targets pathways that are necessary for B cells to survive. As such, they tend to have fewer horrible side effects than traditional chemo (though are still some side effects).

In this trial, 53.6% of participants achieved a response, and it lasted just a shade under a year. 89% of patients achieved at least some shrinkage in lymph node size.

The study was led by Dr. Salles, who was featured in a video with Dr. Cheson that I posted just a few days ago, discussing this very treatment (and other topics). As Dr. Salles said then, these treatments work pretty decently on their own, and seem to also increase the effectiveness of more traditional chemo.

There are a few people in my support group who are being given Idelalisib. Not sure if they are in this trial, specifically, but they seem to be generally happy with the results.

I assume we'll be seeing more of this in the months and years to come.

ASCO: Do Scans Actually Help?

Another one of those reviews of the ASCO conference that I expected would be helpful -- this one from Dr. Anne Blaes from the University of Minnesota, called "Symptoms, not surveillance, as effective at detection of relapse in some cancers." 

Dr. Blaes works with cancer survivors, and was particularly interested in some of the ASCO presentation on imaging -- the use of CT and PET scans, especially in helping to discover relapses. Most survivors want to know just how often they'll be scanned after they've had a response to treatment. (I know I do.)

She describes two particular lymphoma studies, one for Diffuse Large B-Cell Lymphoma patients and the other for Hodgkin's patients. In the DLBCL study, 500 patients were followed, and given follow-up scans every 6 months for 2 years (which is standard). Only 1.5% of those scans actually detected a relapsed lymphoma. In the Hodgkin's study, a similar result was shown: little benefit for routine follow-up scans so frequently.

The costs for scans are high, in emotionally (anxiety, false positives), physically (all that radiation), and financially (in one of the studies, detecting just one relapse cost about $600,000, and that's not calculating what happens after the detection).

As Dr. Blaes points out, those scans, while they cause some anxiety, also make us feel good -- we have proof that things are OK (or that things aren't OK). But maybe they aren't worth what we get out of them.

Just as effective? Regular blood work, physical exams, etc.

This kind of study makes me more and more pleased with my own beloved Dr. R, who won't do a scan unless he has a reason, all part of his larger "Do No Harm" philosophy. I would think that just an approach would even more important for Follicular Lymphoma and other indolent cancers, where (hopefully) problems aren't going to pop up too quickly.

There's a balance that takes a while to come to a Follicular Lymphoma patient -- a need to stay vigilant with a need to be able to just let it go -- but it does come. We learn to know our bodies, and to recognize when something just isn't right. When we learn to trust that sense, and our doctor's knowledge, the things get easier.

(Not easy -- just easier. Let's not get carried away....)

ASCO Sum Up

As I said last week, I figured someone would do a summary of the good stuff from ASCO, and now Medscape has just such a summary, featuring Lymphoma Rock Star Dr. Bruce Cheson and Dr. Gilles Salles, who's pretty darn good himself (and who was featured in a Patient Power video about ASH that I linked to recently). The two discuss some of the take-aways about lymphoma (in general, not just Follicular Lymphoma) from the ASCO conference.

They say there are four pretty noteworthy trends:

1) Chemo has disappeared. There are no new traditional chemotherapies being developed for lymphoma, and I can't imagine there will ever be anymore ever again. The old stuff (Bendamustine and CHOP, for example) will hang around for a while, but with so much immunotherapy, biological treatments, kinase inhibitors, etc. etc. being developed, the "shotgun" approach of chemo is pretty much a thing of the past. Chemo will hang around, like a used car with a tape deck, because we all have the high school mix tape still sitting under the front seat; but from here on out, we're all mp3, folks. Metaphorically speaking, of course.

2) That said, there was still lots at ASCO on targeted-therapy combos: new treatments that home in on lymphoma cells, but combined with traditional chemo or monoclonal antibodies to increase their effectiveness. Kinase inhibitors are big among targeted therapies these days, especially GS-1101/Idelalisib and Ibrutinib. They seem less likely at the moment to give a Complete Response that lasts, so the combos are a better bet. The problem there: the companies that make them don't play nice together, and they cost a whole bunch of money.

3) How should we approach Follicular Lymphoma? Should we try for a cure? Or are we better just treating it as a chronic disease and accept that we should hold it in check for the rest of our lives? Dr. Salles thinks we shouldn't give up on a cure (and I agree), though treatments that hold things in check are a good idea. Still, he's not crazy about the idea of someone taking pills for his entire life (and Cheson implies that this would benefit drug companies more than patients, which is part of what makes him a Rock Star). But Gilles isn't convinced that, over time, we won't see more mutations of clone cells (that is, the cancer cells will find a way to change and thus resist the treatments), so he's not ready to throw out chemo just yet.


4) PETs were also a topic at ASCO. They are used for initial staging and response checks (and endpoints -- determining if a treatment really worked). Maybe we don't need repeated PETs, though, as checks between treatments? Other ways of checking might work as a way of measuring growth of the disease without so much radiation exposure. I'm with Drs. Cheson and Salles on this, and so is my own Dr. R; until a blood test or a physical exam shows a reason for a PET, I'm probably not getting one. (Though every now and then, I think I'd really like one, just to check that everything is OK with those deeper nodes that aren't so close to the surface.)

So, this isn't all necessarily about Follicular Lymphoma, but it's a pretty nice summary of some very up-to-the-minute trends from two guys who know what they're talking about.

Lots to look forward to in there.

Detecting Disease in Follicular Lymphoma

The most recent issue of Therapeutic Advances in Hematology has a dense but fascinating article called "Clinical Implications and Prognostic Role of Minimal Residual Disease Detection in Follicular Lymphoma," written by a team of researchers from Turin, Italy. The article has some important implications for detecting residual disease -- those little bits of cancer that hang around after what seems like a successful treatment, and which can be very hard to find.

As most of us know, Follicular Lymphoma has a bad habit of coming back after treatment, even successful treatment. Sometimes it comes back more aggressively (and I mean that it returns as FL, not as a transformed disease), and the earlier the returned lymphoma can be caught and treated, the more successful the treatment generally is. Right now, it's hard to predict how Follicular Lymphoma will behave. About the best we have is a FLIPI score (which I'm not going to explain.  See Lymphomation.org's typically excellent description of what FLIP is. Or just ignore it, if, like me, you're the type that hates numbers).

The authors of the article discuss PCR-based MRD detection: PCR stands for Polymerase Chain Reaction, and MRD for Minimal Residual Disease. So this is a method for detecting whether or not any cancer remains after treatment. It's the "PCR" part that is so exciting.

Even after what is deemed to be a Complete Response, some cancer cells might remain, including cells that can hang around for a few years and then explode into a full relapse. (OK, "explode" is a little dramatic, but sometimes things do happen quickly -- always a concern). A PET scan might not be able to detect the tiny amounts that remain, and that are enough to potentially cause such a relapse.

The PCR-based method, however, is sensitive enough to find them. Basically, it works by detecting cells that have a particular molecular mutation. In this case, that mutation is a switch of two chromosomes (14 and 18) that is typical of Follicular Lymphoma. The mutation causes some other things to happen (I'm going to skip the details), and this results in "antiapoptosis" -- the cell is prevented from dying a normal death. Right now, about 55-70% of Follicular Lymphoma patients have the molecular structure described above (the skipped details) that would allow detection by PCR-based methods. The authors of the article argue that it wouldn't be too tough to develop a test that allow most, if not all, of the remaining FL patients to have residual disease detected, too.

PCR-based methods, then, are superior to what we have now because they can detect disease at such a small level. PET scans work well in detecting disease in lymph nodes, but not in bone marrow. By looking at individual cells, PCR-based methods can detect tiny amounts of disease no matter where they're hiding.

These method have been used for some time in other blood cancers, such as Acute Lymphocytic Leukemia. Their use in Follicular Lymphoma has a bright future, particularly, say the authors, as a tool in clinical trials, allowing researchers to understand in a more detailed way just how well a treatment is working.

So, this isn't about a breakthrough treatment, but it supports potential breakthrough treatments. It may be a quiet way of helping us all out some day.

Happy Birthday, Gene Wilder

To celebrate the birthdays of Gene Wilder (80 today) and Johnny Depp (50 this week), Yahoo! staged a little Wonk-off, pitting Wilder's and Depp's portrayals of Willy Wonka against one another.

Of course, Gene Wilder comes out on top.  Mostly because Depp's is so damn weird. But also because Wilder's Wonka is so awesome -- hard to figure out, but with a good heart.

The Wonk-off reminded me that Gene Wilder is a Lymphoma survivor -- he's been in remission for years thanks to a stem cell transplant.

I wrote about Wilder in Lympho Bob about a month after I was diagnosed. He was one of those people whose story gave me hope. (Unfortunately, the link from the blog post, to a video for an interview with Wilder, doesn't work anymore.)

And in addition to being a survivor himself, Wilder has long been a cancer advocate, helping to found Gilda's Club, in honor of his wife Gilda Radner.

So, in honor of his birthday, some videos of Gene Wilder that actually work. That first video interview made me feel a little better five years ago. These videos make me feel good all the time.

More on Sequestration

I wrote a while ago about the federal government "Sequester," and the potential it had for harming cancer patients.

The "potential" harm is, unfortunately, becoming actual harm, and the last couple of weeks have seen some problems come to light. A survey of oncologists sponsored by ASCO shows that about 80% of them have had their practices affected by the cuts.

Some members of Congress have taken notice and are asking their colleagues to make an exception for cancer patients the way they made an exception for FAA funding, allowing budget money to be shifted around to cover funding shortfalls for Medicare patients. The sequester had cut Medicare chemotherapy treatment payments by 2%. Doesn't sound like much, but the result has been that smaller clinics and private practices, especially those that are not near hospitals, have been turning patients away. Those near hospitals are sent to the hospitals for treatments. Others are out of luck or forced to travel -- a hardship for many who are on Medicare.

124 members of Congress wrote to the Centers for Medicare and Medicaid Services, asking them to shift some items in their budget. Unfortunately, the Director of the CMS told them that she does not have the4 authority to do so.

There's currently a bill in the House, sponsored by Rep. Renee Ellmers (R-NC), a former nurse, asking that cancer treatments be exempt from the sequester. It's slowly making its way through the process.

I hate to make Lympho Bob political, because, frankly, cancer doesn't recognize political affiliations. But the lack of health care for people in our country is sometimes just barbaric. As I've said before, I've known too many people who have died because they couldn't afford treatment. That really makes us no better than most 3rd world countries. Help is available, and people should be able to get it.

I hope Rep. Ellmers and her co-sponsors can make this small thing happen.

Birthday 5k

I usually try to be all reflective on my birthday, but I'm too dang tired. I celebrated by running in my town's inaugural 5k road race. Did pretty well, too -- way better than I expected.

I haven't run a race in almost a year, sine the infamous "Independence Day Choke Job of 2012." I've been running steadily since then, of course, so I'm in OK running shape. But a few things were conspiring against me that were making me think this wasn't going to be a great race:

• My work schedule has changed in the last three weeks, making it impossible to do any weekday runs. I've been getting by on Saturdays only, so for almost the last month, I've run only four times. 
• My asthma has been very, very bad lately. The tree pollen is so think in the mornings that I have to use the windshield wipers just to get out of the driveway.
• The course was described on the website as "hilly." Since this race was 5 minutes from my house, I kn ow the streets it was run on. "Hilly" puts it very optimistically.

So I wasn't expecting a very good time. I usually finish these things in about 30 to 31 minutes, give or take. I was fully expecting this one to take about 35 minutes. And to suck.

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I picked up registration stuff Friday afternoon. Nice to save a little time before the race. I asked the registration volunteers (who were very enthusiastic) what kind of a crowd to expect, and they said about 300 runners. "Great," I said. "I guess this means I won't be getting a prize for my age group." They very sincerely told me not to think that way, that anything could happen. "Maybe we'll have a special category just for you," one of them said. I was about to say, "Well, I usually win my sub-category -- 40-49 year old males with incurable blood cancer." I held off saying it. No sense in dampening their enthusiasm.

I got to the race about a half hour before it started, which gave me time to warm up, listen to some music, etc. Isabel let me out of the car by the entrance to the parking lot where all of the activity took place, across the street from the starting line. As I got out, more very enthusiastic volunteers yelled at me, "The starting ine is THAT way!," pointing in the opposite direction from where I was walking. "THAT way!" they yelled some more, as I kept walking. "Yes," I said, "but the bathrooms are THAT way." Very enthusiastic volunteers, though I don't think many of them had actually volunteered at a race before.

There was no line at the port-a-potty, which was nice, and I did a brisk walk and jog around the parking lot to warm up, listening to some music. I felt fairly serene. I usually try to take this time to pick out people that I can probably beat, and then target them during the race. But this time, I thought to myself, You know what? Just enjoy the run. Don't worry about the time, or who else is running. Just run and enjoy it.

I walked with the crowd to the starting line, with about 10 minutes to go, listening to more music and enjoying my serenity. And then I saw someone I know. We chatted a few minutes, nothing too heavy, and then I thought to myself, Damn. I need to beat him. I can't lose to him. It wouldn't be horrible if I didn't -- he's a great guy, and would never hold it over me or anything. But I need to beat him. So much for serenity.

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The start went off fine. The starter didn't have a bull horn, so I couldn't hear any of his instructions from the middle of the pack. (There's a pattern here. Lots of enthusiasm for this race, but lots of little details that will need to be worked out for the second running next year.)

A field of 300 runners is a pretty nice size. Not too crowded, but enough people that you aren't likely to be left alone along the route. The were a lot of newbies, which is also OK for a race of this size. I heard a couple of "This is my first race!" comments for the first quarter mile. And at the start, a trio of college girls jogged in place and said, "We should look like we know what we're doing!" (which meant they should probably be conserving energy instead of jogging in place).  I didn't see anyone that I felt like I should make sure I beat, but there were some possible candidates (including the three jogging-in-place college girls).

The route was nice and flat...for the first three minutes. Then that "hilly" comment from the web site started to come in to play. But here's the thing: "hilly," to me, implies that there are a bunch of hills. It does NOT mean "One continuous hill for a mile." That's what I was thinking at first, anyway. We hit one long, medium-steep hill. Lots of folks dropped off to the side to walk about half way up. Here's where I started to think about passing people, which I did. They included a dad and his 8 year old son. I could hear dad lecturing his son about taking it easy, but the kid was basically running in slow motion, trying to hold himself back.

The hill was kind of horrible. At the crest, it leveled out, and then was followed by another small hill, and then a small downhill, and then another hill. It sucked. the first two miles was just hill after hill. I tried to keep my pace consistent, but going uphill so much feels like things are going very, very slowly. There was a water stop at the halfway point, and I looked at my time: about 18 and a half minutes. This was not going to be my best race. in fgact, it could very well be my worst.

I tried to stay upbeat about it (there was no sign of my friend anywhere, so I'm pretty sure I beat him). The 8 year old passed me at one point -- I hadn't remembered passing him. that happened two more times, with him zipping past me, and my not remembering passing him. The third time, I watched him. He was passing me, and then running along the sidewalk in the opposite direction, going back to his father. The kid was basically running the race twice, running ahead, then back, then ahead again. I stopped looking at him because he was making me tired.

The final mile was, they promised "downhill." And it sort of was, for about a half mile, and then it was uphill again, and then flat for the last little bit. As we were nearing the finish, I could see about six people in front of me, including the trio of college girls, who were clearly struggling. I still had a little left in the tank, so for the last 200 yards of so, I sprinted. I passed them all, and finished in a very decent time of 31 minutes and 57 seconds. Not too bad at all.

(One quick "back to reality" note here: Isabel videoed that last 200 yard sprint. Now, when you're in the middle of that, you feel like you're going 100 miles an hour. But looking at the tape, I could see just how comically slow my sprinting really is. I think I'm a Harley, but I'm more like a moped. It's quite humbling.)

One more "things they need to change for next year" note: they had no water at the finish line. We were supposed to walk the quarter mile back to Health Expo for water and snacks. I just walked in the other direction, to the car. After sprinting as hard as I did, I just wanted some water. Not having it right there is, to me, a pretty big mistake.

But overall, it was a nice race, and I was pleased with my performance.

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The race started at 9:00, I took a half hour, plus the walk to the car and the quick drive home, I was home by 9:55. Which was great, because my 11 year-old-daughter had planned to go to the hair salon at 10:00, so Isabel was able to get her right into the car and drive her there.

A pampered 11 year-old girl, off to the hair salon? What is, this, a Real Housewives of Connecticut episode?

Hardly.

My girl had an appointment to get her ponytail cut off, so she could donate it to Beautiful Lengths, and it could be made into a wig for a cancer patient. This is the second time she's done it. She was 9 the first time, and she's spent two years growing it out, with the specific purpose of donating it again. She's cute as heck with short hair, but that's just a bonus.

I heard someone say once that, when all was said and done, he didn't want to be judged on his own actions, he wanted to be judged on what kind of people his children became.

By those standards, I am more than prepared to be judged. On all three of my kids.

That's the best birthday gift of all.

ASCO: Follicular Lymphoma Transformation

One more from ASCO: "Changes in the Tumor Microenvironment Associated with Transformation in Follicular Lymphoma," from researchers at the Mayo Clinic.



There's been more and more interest in Microenvironments in the last few years. Microenvironments are, basically, the stuff that immediately surrounds a cancer cell. The idea is that maybe it's not just the cancer cells that need to be taken care of. Maybe it's the way that they interact with what's around them -- maybe there are little enablers hanging around that make things worse.

Transformation is, of course, a Follicular Lymphoma patient's worst fear -- that our nice slow-growing cancer will turn into a nasty fast-growing cancer. It happens to anywhere from 15-50% of us (depending on who you ask). The question is, Does transformation come about because of the nature of the cells themselves? Or is it some other kind of interaction with the cells that makes them more likely to transform?

The Mayo researchers identified seven different elements in the microenvironment that could possible have an affect on transformation. They ultimately identified two elements that seem to predict a short period before transformation (CD14+, a type of white blood cell, and PD-1+, a protein that plays a role in cell death). It seems like fairly early research, but certainly something worth keeping an eye on. No discussion on the clinical applications of this, but I could see maybe testing of some type to identify susceptibility to transformation, with the aim of catching it early (?).

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Overall, this ASCO has been a little disappointing in a way. No real blockbusters in the Follicular Lymphoma category, and not many in the broader Lymphoma category, either. I usually see a wave of press releases touting the significance of the presentations, but it's all been pretty quiet. Maybe Patient Power or Medscape will offer some kind of review in the next few weeks, with some Lymphoma Rock Star getting me all excited about the long-term significance of a small study.

I could go for that.

ASCO: Ibrutinib and Follicular Lymphoma

My laptop has been in the shop for 2 weeks. The IT came back with it today, but he'd forgotten the new battery he promised. And then he tried to move all of my data back to my brand new hard drive (which was the real problem) and found that it hadn't all copied over from my old, broken hard drive. He's going to try to fix it, but he has a meeting at 1:00, and may not get to it. [I aso heard about his mom's health problems, which have been taking lots of his time and making him distracted. I can't get mad at him. I know where he's coming from.]

So, it looks like I have my netbook loaner for at least another day. Small screen, weird keyboard, slow connection speeds, tempermental internet browser -- takes about 2 or 3 times longer to do what I want and need to do than usual, but I'm dealing. We cancer patients -- especially those of us who have watched and waited -- are a flexible, patienmt bunch, who know how to keeps things in perspective, aren't we?

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In the meantime, here's another report from ASCO, which ended yesterday: an early report from a phase II trial of Ibrutinib in Follicular Lymphoma patients. The trial itself is ongoing, and looking to recruit 110 FL patients. (See the trial info here from ClinicalTrials.gov.)

Ibrutinib, of course, has been on the cancer radar lately, showing some strong results for different types of lymphomas. As the report indicates, Ibrutinib is a BTK inhibitor, messing with various pathways and microenvironmental elements in ways that make it hard for cancerous B cells to survive. Earlier research showed that about 60% of Follicular Lymphoma patients will have a form of FL that will make them open to Ibrutinib.

Early results from the trial show that this is roughly the case. Of 11 ptaients so far, 3 have shown complete responses, and 3 have shown partial responses.

So that's great news. It will be nice to see further updates, maybe at the ASH conference in December.

Cancer Survivors Day

Good gravy, what a busy day. Here it is 8:00 at night and I haven't wished everyone a Happy National Cancer Survivors Day!

The National Cancer Survivors Day Foundation makes it pretty clear what they mean by "Survivor": "anyone living with a history of cancer – from the moment of diagnosis through the remainder of life." No arbitrary 5 year milestones, or clear scans, or anything else. You heard The Words, even once, and you're in The Survivors Club.


The Foundation's logo kind of looks like a figure skater. I'm going to pretend it's Katarina Witt, two-time Olympic gold medalist for East Germany. She's not a cancer survivor, as far as I know, but she was fun for a teenage boy to watch.



Anyway, Happy Day to all you cancer survivors. Look forward to tomorrow, and then enjoy it while you have it.