Another Cancer-Sniffing Dog

From a story last week:

Bella the cancer-sniffing dog. She detected her owner's breast cancer before the mammography did. She threw up while her owner was going through chemo. And she's the subject of a book. Very cool dog.

This is why I missed my dog so much when I was away (even though she never detected my cancer).

Promising RIT for Follicular Lymphoma?

There's a new cowboy in RITville.

(OK, that metaphor isn't my best. I'm on vacation.)

There's a new version of RIT that may be available at some point. Results from an early clinical trial look good.

RadioImmunoTherapy (RIT) is a fairly effective, but fairly underused type of treatment for NHL. Right now, there are two versions of RIT available, Bexxar and Zevalin. They are both effective, and have some differences between them that make the choice of one or the other better for some patients. (Lymphomation does an excellent job of comparing the two, which isn't surprising, because they do an excellent job at pretty much everything.) RIT works by providing radiation to lymphoma cells. Because blood cancer cells are moving targets, traditional radiation treatments don't work. So RIT treatments use something that can find and attach themselves to cancer cells (like Rituxan) and have that molecule carry a tiny dose of radiation, delivered directly to the cancer cell. Pretty cool system.


The current issue of the Journal of Nuclear Medicine reports on the results of a clinical trial for a version of RIT that uses luteum-177, added to Rituxan, as its delivery method. Lu 177 differs from the other RIT types because it doesn't penetrate tissue as deeply (and therefore won't travel too far beyond the targeted cancer cells, sparing more healthy cells).

The purpose of this trial was to determine the best dosage for this treatment, and it seems like they got decent results -- about 52% of patients got a response (29patients overall; 6 had a complete response and 9 had a partial response).

However, the results for the group of patients with Follicular Lymphoma were particularly good (it "appeared to have striking activity in follicular lymphoma," said the authors). of the 11 patients with FL, 9 had a response, for an 82% response rate. Excellent.

It's an early study, so it will need to go through more steps, and recruit more patients for tests. And then, there's the whole issue of whether or not it will be practical -- that is, whether or not it will run into the same problems as Zevalin and Bexxar, with their reimbursement and logistical problems. But maybe this will be the one that gets some attention and forces a re-evaluation of the uses of RIT.

Intestinal Bacteria and Lymphoma

I'm a little hesitant to link to this article, but I'm going to anyway, because I think it's pretty fascinating.

Researchers from UCLA's cancer center have found a potential link between lymphoma and certain types of gut bacteria. The presence of these bacteria seems to play a role in encouraging lymphoma growth.

I can't access the full online article, but that link is to a press release from UCLA.

I'd like to see the full article because I have some hesitancy about this one. If it plays out, it could be pretty great -- treatments could be developed that kill off bad bacteria and encourage good bacteria in the gut.

But I can also see this going in a less-good direction -- claims that Greek yogurt will cure cancer.

My biggest reason to be hesitant, though, is that the study involved mice, not people. Lots of strange things happen when bacteria are moved from one organism to another.

I'm especially interested in this because of my own gut issues, and I'd like to see if there's some connection between them. But that's going to take some serious research.

We'll file this one under "keep and eye on it."

Jon Lester

CNN.com ran a nice piece a couple of days ago written by Jon Lester, Boston Red Sox pitcher and lymphoma survivor. The piece highlights Lester's charity, NVRQT, which stands for "Never Quit"; the group focuses on pediatric cancer -- supporting research AND supporting kids with cancer.

I am, of course, a Boston native, and a life-long Red Sox fan, so Lester has played a pretty big role in my cancer life.

Lester was diagnosed with Anaplastic Large Cell Lymphoma in 2006. It's an aggressive NHL, and he went through some heavy duty chemo, returning to the Sox in 2007, and pitching in the decisive game 4 of their World Series victory that year.

I was diagnosed a few months later. When we broke the news to the kids, I had my arms around my boys. My oldest was the one who best understood was was going on with me, and I told him he'd heard of NHL before, reminding him about Jon Lester.  When he heard Lester's name, his whole body relaxed in my arms. He knew things were going to be OK. Of course, Lester had a very different type of Lymphoma that I have, but that didn't matter. What mattered was that he became a kind of symbol for us of someone who overcame this.

About 4 months after I was diagnosed, Lester threw a no-hitter. I turned on the game in the 8th inning and saw that Lester was three outs away from the no-no. I got my son out of bed, and we watched Lester finish it up. Needless to say, it was a pretty big day in our house.

And, of course, I wore my Jon Lester shirt for every one of my Rituxan appointments.It's still my lucky shirt when I need one.

Lester's not having a great year on the mound, and there is once again talk of trading him in the next couple of weeks. If that happens, I'll be pretty bummed. But it doesn't mean I won't get myself a new shirt.

Jimmy V

The ESPY Awards are being presented tonight. They're basically celebration of sports. I haven't watched them in years, though I did see a notice for them today, which made me at least look at who was up for awards this year.

There's a sad, sad lack of Boston pro athletes and teams on that list. But I do take a little comfort in several mentions of Louisville athletics. It's something, anyway.

But what it also made me think of was Jimmy V. This year is the 20th anniversary of Jim Valvano's moving speech at the ESPYs (back when it was shown in March).

If you've never seen it, or you haven't seen it in a while, it's worth a look.



Valvano is sick. His cancer was spreading fast, and he could barely get out of bed that day to receive the Arthur Ashe Courage Award. But the crowd gave him strength. His 3 minute speech went on for 10 minutes (he ignores the 30 second warning in classic fashion). He tells a very funny story, and he gives advice for living a full life: Every day, do three things -- laugh, think, and cry. It's advice that I still think about.

And he announced the formation of The V Foundation for Cancer Research, which has given away millions of dollars to cancer researchers to study a wide variety of cancer-related problems, including several dealing with lymphoma.

(By the way, this year's Arthur Ashe Courage Award winner is Robin Roberts -- an all-time great in basketball at her alma mater, Southeastern Louisiana University, and one of the first female anchors on ESPN's Sports Center, and, of course, cancer survivor.)

So good luck to whoever is up for an ESPY. May you use your fame for the good.

Follicular Lymphoma: GA101

The journal Blood has published the results of a phase 2 clinical trial involing GA101 (also known as Obinutuzumab) and chemotherapy. Results were very positive -- enough to consider Obinutuzumab as a possible alternative to Rituxan (?).

Obinutuzumab is similar to Rituxan, in that they are both monclonal antibodies that target the CD20 molecule on B cells. There have a been a whole bunch of monoclonal antibodies developed since Rituxan, though none really seems to do a better job. Obinutuzumab is different for two reasons: first it is fully humanized. That is, unlike Rituxan, which was developed from mouse cells, Obinutuzumab was developed from human cells. There is some speculation that this difference means fewer allergic reactions.

More importantly, Obinutuzumab is glycoengineered. Glycoengineering is a process whereby certain sugars on the antibody molecule are changed to the molecule attaches to its target more easily. Combine those two qualities -- better attachment and fewer side effects -- and you just might have an improvement on Rituxan.

The results from this clinical trial aren't going to determine whether we have a Rituxan replacement.

But it does point to the effectiveness of Obinutuzumabin combination with CHOP.

The trial involved combining Obinutuzumab with either CHOP or FC (Fludarabine and Cyclophosphamide), The important results are 1) there were no significant side effects (though there were more with FC than with CHOP), and 2) it's a pretty effective combination: 96% of patients receiving the CHOP combo had a response, and 93% of FC patients received a response.

Pretty darn good.

It's a phase 2 trial, so its goal is to prove that a phase 3 trial is worth conducting -- one with more participants, to show that the results can hold.

And this one trial won't really solve much, given all of that. I still contend, as I've said several times recently, that chemo is probably on its way out (though it won't disappear completely as an option -- it will diminish in use). So these results are great, but they're not the long-term solution we're looking for.

Stage 1 Follicular Lymphoma

I don't know how much this applies to most people who read Lympho Bob, but it's interesting nonetheless: some research from France on the impact of the choice of initial therapy on  Stage 1 Follicular Lymphoma patients.

Stage 1 Follicular Lymphoma describes patients who have been diagnosed with FL in one location -- a single cluster of lymph nodes, maybe under one arm. It's pretty rare to be diagnosed so early; the numbers I usually see say something like 10% of patients are diagnosed at stage 1. Most of us are at stage 3 or 4 -- involvement at multiple sites, above and below the diaphragm, maybe some organ involvement, too. Staging for Follicular Lymphoma isn't as important as it is for solid cancers. The same treatments are likely to work for stage 4 as for any other stage. Staging is about location more than intensity.

Except with stage 1. Traditionally, stage 1 Follicular Lymphoma is the one type that's thought to be curable. Because it is isolated to one area, it can often be treated with traditional radiation, and sometimes is cured.

This article looks at whether or not radiation is still the best option. No one has really revisited that since Rituxan became popular.

The researchers looked at 145 FL patients with stage 1 or 2 disease, and divided them into 6 groups, based on the treatment they received: 1) watching and waiting, 2) chemotherapy, 3) radiation, 4) radiation + chemo, 5) Rituxan, and 6) Rituxan + chemo.

The results were kind of mixed, in my opinion (and the abstract kind of fudges things a bit). While Rituxan had the lowest Complete Response rate (57%), and Radiation + Chemo had the highest CR (94.7%), both groups had the highest overall response rate -- 100%. But Radiation + chemo had a high relapse rate (84%), second only to straight radiation (90.5%). Rituxan's was 42.9%.

Their conclusion is that none of this seems to affect Overall Survival. Even the watching and waiting group had the same OS as everyone else -- pretty much in line with other studies, no matter what the stage.

Radiation might give people a shot at a cure, but if it doesn't work, it's not going to help them any more in the long run than if they'd just watched and waited.

These kinds of retrospective studies -- looking back at a group of patients -- are interesting, but they seem kind of misplaced at this point. They started long ago, I know, so they need to be finished and results need to be reported. But when the conclusion reads that immunochemotherapy [that is, Rituxan + chemo] is the best option when treatment is necessary, I think it speaks to some old-school thinking. I'd like to see people at least make a nod to some of the exciting stuff that's happening these days.

Michigan

This is a cool story:

Grant Reed is 12 years old. Last year, he was diagnosed with a brain tumor, and had it removed in a 16 hour surgery. Then he had radiation, chemo, and spent some time in the hospital.  He had his final chemo session last week. He's doing well.

Grant is an Ohio State Buckeyes fan. His parents met while playing in the OSU band, and the family is still religious about watching games, especially OSU's arch-rival, Michigan. If he was in the hospital on weekends, Grant watched the games from his bed. He even got a visit from OSU coach Urban Meyer while he was in the hospital.

The best part of all of this? To inspire himself to fight, he named his tumor "Michigan."

Ah, the passion of youth. Brings back the days of burning Yankees baseball cards on the grill during summer cookouts. Though these days I kind of regret burning that Thurman Munson rookie card.....Seemed like a really good idea at the time.....

My apologies to my Michigan friends, including Lymphoma Rock Star Betsy de Parry and my pal Kalamazoo Mary. But, really, it's a pretty cool story, don't you think?

Follicular Lymphoma: Cells of Uncertain Origin

Just about to be published in Haematalogica:  an article with maybe the most awkward title ever, but with some interesting information about cells that may become Follicular Lymphoma cells.

First, here's the title: "Follicular Lymphoma-like B-Cells of Uncertain Significance (In Situ Follicular Lymphoma) May Infrequently Progress, But Precedes Follicular Lymphoma, Is Associated with Other Overt Lymphomas and Mimics Follicular Lymphoma in Flow Cytometric Studies."

I absolutely love that the cells are called "Follicular Lymphoma-like B-Cells of Uncertain Significance." It just sounds too much like the Rodents of Unusual Size from The Princess Bride. [Important not to my mom: -- Do NOT click that link! It's a video of a giant rat!]

Now I have visions of my nurse in the treatment room holding a sword to a cancer cell and saying, "Hello. My name is Sue. You have sickened my patient. Prepare to die." [Important note to my mom: That one's OK.]

So here's the deal: "Follicular Lymphoma-Like B-Cells of Uncertain/Undermined Significance" used to be called (and are sometimes still called) In Situ Follicular Lymphoma cells. "In situ" is a Latin phrase meaning "in position." Oncologists use "in situ" to describe cancer cells which are still in the place where they originated; that is, they haven't broken off and metastasized. Follicular Lymphoma, being a blood cancer, is kind of constantly metastasizing, in a sense -- it is a "systemic" cancer, meaning the FL cells are in the blood and can travel pretty much anywhere the blood travels (which is pretty much anywhere).

In Situ Follicular Lymphoma, then, involves cells that are sorta like FL, but not quite, and which kind of sit in the lymph nodes and don't take off quite yet. The idea of In Situ Follicular Lymphoma has been around for a while (maybe 10 years?), but no opne has been quite able to figure out what the cells are. Maybe pre-FL cells? Maybe the start of some other blood cancer? Maybe just weird cells that are what they are and nothig more?

The study above with the awkward title involved looking at In Situ Follicular Lymphoma cells and trying to figure out just what they were. The authors acknowledge that we don't really have answers to those questions because the information that we do have seems to all conflict.

They looked at 31 biopsy samples, and ran them through a flow cytometer, a very cool machine that lets researchers look at individual cells and their characteristics, like their size and various features. Quite the instrument.

What they found was that 52% of biopsies with In Situ Follicular Lymphoma were related to a previous or currently diagnosed lymphoma (which would suggest that FL grows out of those cells). However, after following those patients for over 2 years, they found that only 6% of them actually developed into lymphoma.

Their conclusion is, basically, those cells might turn into FL, but they might not.

The big lesson from this seems to be directed toward other researchers:  don't just assume that In Sutu Follicular Lymphoma (or Follicular Lymphoma-Like B-Cells of Uncertain/Undermined Significance) will lead to Follicular Lymphoma.

I think this is ultimately one of those studies that is valuable not because it tells us something new, but because it slows us down.

Personally, I'd like to see more than 26 month follow-up on the In Situ cells. Wouldn't an indolent lymphoma potentially take more than 2 years to develop? Just a thought.

Interestingly, another article on this topic came out a couple of months ago, and had a very similar conclusion.  It will be interesting to see if more research on the topic continues, and if they ultimately find some connection between the FL-like cells and actual Follicular Lymphoma.

Overview of Lymphoma Therapy

Here's a nice slideshow called Overview of Lymphoma Therapy, posted a couple of days ago, delivered a couple of weeks ago, from Dr. Anne LaCasce. It comes from Dana-Farber, via The Pan-Mass Challange, via my brother.

[Did I mention that my brother is riding in the Pan-Mass Challenge in a month or so, biking many miles to raise money for cancer research? He is still happily accepting donations for his ride....]

The presentation starts with a history of chemotherapy, then discusses radiotherapy and "newer therapies" (including Rituxan, which is not really new) and kinase inhibitors (briefly), and then gets into standard therapies for different lymphomas (including indolent lymphomas, which is where Follicular Lymphoma gets covered).

It's a lot to cover in 30 minutes; there are, by some estimates, well over 30 B-cell lymphomas, plus some more T-cell lymphomas, plus Hodgkins, so it's necessarily pretty general. I'm not sure who the audience is -- if she's really doing this in front of people, or just recorded it for readers of the Dana-Farber blog -- but she's also assuming her listeners are not experts.

I, personally, would have preferred more on the cutting-edge and future treatments, but I can't complain too much. She does mention that it's likely we'll see less chemo and more targeted treatment in the future, and spends a few minutes of novel pathways and the drugs in clinical trials; she mentions Ibrutinib, specifically -- more evidence of how excited people in the field are about it.

Overall, it's a pretty good overview for where the larger field is right now. I always like to see different perspectives on where we are, to see who is excited about what, and where people think we are going.

Nodes of Gold

It's been a long time since I've done Nodes of Gold entry; the last was in January 2012. It is unfortunately time for another.

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Nodes of Gold is my series of profiles of famous people with Lymphoma. There have been a bunch -- Gene Wilder, Mr. T, some pro athletes, including Red Sox pitcher Jon Lester. "The very rich [and famous] are different than you and me," said F. Scott Fitzgerald. ("Yeah -- they have more money," replied Ernest Hemingway.) But they are the same in one respect -- they can get lymphoma. We should take comfort in that. And we should appreciate when famous people are willing to talk about their lymphoma, because it makes people more aware.

Today's entrant in the Nodes of Gold pantheon is Vivian Campbell, guitarist for Def Leppard. He has also played for the bands Dio, Whitesnake, and Thin Lizzy. But, for me, it's the Def Leppard work that means the most. Campbell was diagnosed with Hodgkin's Lymphoma in the spring. He's undergoing chemo this summer, but expects to ply some shows with Def Leppard in the next few weeks.

Now, Campbell joined Def Leppard in 1992, which was way after my own Def Leppard phase. By the time Campbell joined Def Leppard, I was already engaged to be married -- to a young lady with her own Def Leppard stories (but those are for her to tell...). My own history is best summed up in the really skinny union jack tie I wore in trbute to the band, It looked something like this, but about half the width:



(Also, I was about twice the width of that mannequin back then, which made the tie look even skinnier. I miss Chess King. And the 80's in general.)

Now, that last  Nodes of Gold that I did was for Tony Iommi, guitarist for the band Black Sabbath. Iommi was diagnosed with "early stage lymphoma" in January 2012 (I still can't find out what type), but he has been talking recently about his experience. He is now doing some Rituxan Maintenance, and seems to be handling things well.

Now here's the strange part of all this:

Beside being in bands that undoubtedly contributed to my high-range frequencies hearing loss, Campbell and Iommi have some connections -- parallel careers that touched, but never crossed.

Iommi was lead guitarist for Black Sabbath, led by Ozzy Osbourne. In 1979, Ozzy left Sabbath to go solo. [My father just found my 8th grade yearbook; Ozzy's "Crazy Train" was listed as my favorite song.] Ozzy was replaced by Ronnie James Dio, who lasted with Sabbath for three years. He left and formed his own band, called Dio.

In the meantime, Dio's guitarist left to join Ozzy's band. Who takes his place in Dio? That's right -- Vivian Campbell.  Eventually, Campbell left Dio to play with Whitesnake and then Def Leppard. Dio eventually formed the band Heaven and Hell....with Tony Iommi playing lead guitar.

What's the upshot of all of this?

To be more clear -- is there some connection between great guitar players and lymphoma?

Probably not, you say. After all, it's only two great guitarists. But what if it was....three?
 



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Most importantly, best wishes to Vivian Campbell as he continues his treatments. And more peace of mind to Tony Iommi as he maintains his good health.