ASH Day! Zevalin and Follicular Lymphoma

It's opening day of the ASH Conference! Woo hoo! Lots of talk about blood cancers from some stupid smart people!

(I'd normally go all Boston with that and say "wicked smaht," but yesterday I overheard two college students talking about the Honors College at their school, and one of them said, "Yeah, you have to be stupid smart to get in there." I love it. I assume he was using "stupid" as an adverbial intensifier, like "very," or "wicked." I'm going to try to find any excuse to use that phrase all the damn time now.)

Anyway, today is the opening day of the ASH conference, and that means lots of drug companies and universities will be putting out press releases over the next week to tout the results of the research that will be reported at the conference. I saw my first last night, from Spectrum Pharmaceuticals.

I like Spectrum's press release, because it mostly gives information without any spin, which some press releases give. (Of course, there's only so much spin a drug company can give without the FDA getting upset.) But Spectrum provides the session numbers and titles of the presentations that involve their products, and some basic information about the products themselves.

They highlight three treatments that are being discussed at ASH. The first is Folotyn, which is discussed as a treatment for T cell Lymphoma and for Multiple Myeloma. The second is Marqibo, also known as Vincristine Sulfate Liposome, which is already approved for Acute Lymphoblastic Leukemia (ALL), and is here discussed as part of a treatment regiment for DLBCL. I like that one of the presentations is substituting Marqibo for a the NON-Liposomal Vincristine in CHOP, which makes CHOP into CHMP, which is perfrect, because Marqibo sounds like the name of a species of monkey that my son the animal lover would be especially fond of.

Enough monkey jokes: Marqibo is like Oncovin, which is the "O" in CHOP, but it is covered in a fat-like substance that slows down how quickly it is absorbed by the body. The idea is that this may cut down on toxicity, and also allow it to stay in the bloodstream and do its job a little longer. That's what the ASH presentations are getting at.

As you know, I know a little about DLBCL, and much less about T Cell Lymphoma, ALL, and Myeloma, so I won't say anything else about those other Spectrum products. But it's the third one discussed in the press release that is relevant: Zevalin.

Zevalin is a type of RadioImmuno Therapy (RIT) that uses Rituxan, which can find CD20 markers on Follicular Lymphoma cells, to deliver a little shot of radiation directly to the cell. It's a very cool, extremely underused treatment for Follicular Lymphoma, and I'm very happy that it's getting so much play at ASH. The other approved version of RIT, Bexxar, has been effectively discontinued by its manufacturer, so we need some good news about Zevalin to keep the RIT option alive for us. Spectrum highlights seven different presentations at ASH that discuss Zevalin.

Not all of the presentations offer good news for Zevalin, but enough of them do for Spectrum top brag about them. They confirm that Zevalin works well when administered after other treatments when there is miminal remaining disease, extending the effectiveness of the initial treatment; but also that Zevalin works well as an initial treatment in indolent lymphoma, even with bulky disease (larger tumors), which seems to go against some previous studies. However, it seems less effective, and less cost-effective, than Rituxan Maintenance.

ALl of which might explain why there was less spin in the press release: kind of a mixed bag when you look at the overall results.

So I'll provide my own spin (reminding you, of course, that this comes from a Cancer Nerd, and not a medical professional): the less-successful outcomes for Zevalin doe not, and should not, spell disaster for it. If anything, they help us narrow down how and when it can best be used. That's ultimately the point of a trial -- to give us fairly narrow instances for when a treatment is likely to be more successful than another treatment. My hope is that there is enough good news about Zevalin at ASH to keep it out there as an option, maybe even to get people just a little more excited about using it. We already know some circumstances when it is useful, and I think the ASH presentations confirm that. Maybe Spectrum knows that, too, and that's why they bothered putting out a press release in the first place.

I would hate to see Spectrum take the RIT option away completely. That would be stupid stupid.