NCCN Congress on Hematologic Malignancies

A few days ago, the NCCN Congress on Hematologic Malignancies took place in San Francisco. The NCCN is the National Comprehensive Cancer Network, a group of cancer research centers best known for their guidelines for cancer treatment. They have a number of meetings every year for different cancer specialists, to give updates on different sub-types. Of course, Follicular Lymphoma was one of the topics of discussion.

I wasn't at the Congress, but OncLive has a couple of articles (one with a video) describing the FL session. (OncLive has a whole series of pieces on the sessions for different blood cancer subtypes, and they posted them almost immediately. OncLive has always been good, but they are just nailing it lately. My thanks to them.)

(While I'm at it, I just want to say that I would love to actually be at all of these meetings, like ASH and ASCO and NCCN and the rest. I wish I had the time and money to go. Maybe some day after i retire.)

(And yes, even though I'm 15 or 20 years from retiring, I do plan to be around until then -- and longer after that.)

Anyway, both articles focus on Dr. Jane Winter from Northwestern University in Chicago. (I believe she was the expert who presented on Follicular Lymphoma.)

The first OncLive article gives an overview of the session. Some of the issues she covered:

•  Stage 1 FL can sometimes be treated with radiotherapy -- traditional radiation. A PET scan can help identify if this approach will be helpful. Up to half of stage 1 patients can possibly be cured with radiotherapy. Unfortunately, fewer than 1/3 of patients who could benefit from this treatment actually get it. (Don't know why, but I suspect that the difficulty of diagnosing at stage 1 might be part of it -- for most of us, we don't actually notice symptoms until stage 3 or 4.)
• For many patients with stage 3 or 4 disease, watch and wait is still an option. The signals that it is time to treat? Symptoms start to show up, threats to organs [that's what happened with me -- swollen inguinal nodes started pushing on things], cytopenia or low blood counts, bulky disease, and steady disease progression. Right now, there is no evidence that watching and waiting results in a lower Overall Survival than treating right away.
• Maintenance Rituxan after a treatment does not offer a better Quality of Life than treating and then waiting for a reason to treat.
• Long-term follow up of patients who received R + Chemo shows that there is no one treatment that prolongs Overall Survival better than others.
• R-squared (Rituxan + Revlimid/Lenalidomide) continues to impress experts, enough that the results of a phase 3 clinical trial might be enough to recommend that the combination replace chemotherapy as the standard choice.
• Patients who receive R-CHOP and then have progressive disease within 24 months have a lower survival rate than other patients. This group accounts for about 20% of Follicular Lymphoma patients. One of the big challenges for FL researchers is figuring out how to identify these patients early, and how to treat them.

The second OncLive article features a short video of Dr. Winter, and a lot of the video focuses on that last item -- the 20% of patients who progress within 24 months. It's good that researchers have been able to identify that group of patients, and it's great that lots of energy is going into identifying and treating them early.

So these articles aren't presenting anything brand new. And that makes sense -- they are reporting on a session that was meant to get oncologists up to date on a bunch of things. But it's always interesting to see what FL experts think is important enough to want to make sure all of their peers know about it. I hope we see more in the near future about that 20% of patients.

(And I'm serious about wanting to go to one of these conferences. If any of you is a kindly billionaire who grants wishes, my email is in the profile on the right.)