Sequencing Treatments for Follicular Lymphoma

This is a little bit old, but I just came across it this week. It's a video from the conference Lymphoma and Melanoma: An International Congress on Hematologic Malignancies. The Congress actually happened about a year ago, but the video wasn't put up until November (and I'm just seeing it now). I don't usually put things up that are so old (because a lot can change in a year), but really liked the video, and I think the information in it is still current, so I'm going with it.

The video is a presentation called "How Do I Sequence Therapies in Follicular Lymphoma?" and it is presented by Dr. Thomas E. Witzig of the Mayo Clinic in Minnesota. The presentation is meant for oncologists, but the information is fairly easy to understand. Dr. Witzig goes through his process of figuring out which treatments to give to a Follicular Lymphoma patient, depending on the patient's tumor burden and whether or not she has relapsed.

One thing I liked was that Dr. Witzig acknowledged in a small way the emotional difficulty that can come with a watch and wait decision. I think that's something that more oncologists need to understand from a patient's perspective.

He also spends a few minutes looking at recent studies that may show that the first two years after diagnosis are the most important. (It has to do with m7-FLIPI scores.) A patient who relapses within two years might be considered a special subset of FL patient, one who needs to be watched and treated much more closely. He's careful to say those two years are important because it allows oncologists to identify who will need some extra attention.

I think it's important to remind everyone about statistics. The charts that he shows that get into what happens in the first two are important, but they only represent trends in a large group of patients. Statistics aren't fate -- someone who is part of a large group will not necessarily behave the way the rest of the group did. Remember that. (And that comes from someone whose greatest moments of sadness have come from looking at statistics.)

He also spends some time discussing RadioImmunoTherapy (RIT), which has some excellent results, but which isn't used very often (for lots of reasons that don't have to do with its effectiveness, but more with how it is given and how it is paid for). It would be great if there were more oncologists (and patients) looking into it.

And he finishes with some excellent advice for oncologists. First, "Know your patient." He mentioned individualized decisions a few times -- there are lots of options available, but some might be better than others, depending on the patient's situation. I'm all for oncologists listening to their patients and figuring out what the patient needs, emotionally as well as physically. The other great bit of advice: "Don't over-treat." Especially with an indolent cancer, sometimes just enough is the best way to go. I can imagine there is a temptation to say, "Well, four doses worked well, so six might be even better." It's probably kind of an art to figure out when to stop, but it's great to hear that reminder.

So, again, this is one of those videos that doesn't really present anything new -- no groundbreaking treatments that we're hearing about for the first time. But it's nice to see a lot of stuff talked about all at once, and it gives us a few things to think about (like RIT) that we maybe haven't thought about in a while.