The ViPOR Trial for B Cell Lymphoma

A few weeks ago, the National Cancer Institute released information about the ViPOR trial. It's a phase I trial, and a really interesting combination.

ViPOR is the name for a combination of 5 different FL treatments that make up this new treatment. They are:
Venetoclax (also known as Venclexta -- this blocks the protein that keeps lymphoma cells from dying the way they are supposed to)
Ibrutinib (also known as Imbruvica -- a BTK inhibitor that messing with things the cell needs to do to stay alive. Not sure why Ibrutinib gets a small "I" when everyone else gets a capital letter. Seems kind of mean).
Prednisone (a steroid that is very common in cancer combinations -- it is the P in CHOP, for example)
Obinutuzumab (a monoclonal antibody, like Rituxan, but created from human cells. not mouse cells)
Revlimid (also known as Lenalidomide, the second R in R-squared, along with Rituxan).

The thinking behind this combination is the same as with so many other combinations -- let's attack the the cancer in different ways so it doesn't have anywhere to escape.

It's a really common approach these days, as we recognize how sneaky cancer can be (block one of its paths and it will find a way around it). It's also an approach that makes a lot of sense to me personally. I remember, years ago, before I even had my first treatment, reading about a study that used Rituxan, then CHOP, then RadioImmunoTherapy (RIT), with the same logic -- three different ways to attack the cancer cells has to better than one, right?

Of course, there are potential problems.

Every treatment has side effects. And so it make sense that a treatment with 5 different agents has the potential to have many different side effects, some of which could be made worse because more than one of the agents can cause the same problem.

This is a phase I clinical trial, and one of the main purposes of a phase I trial is to figure out safety problems -- the Maximum Tolerated Dose -- how much of the agents you can give before the problems outweigh the benefits.

And that will be a challenge. I remember seeing this all discussed on Twitter a few weeks ago, and the folks at Lymphomation pointed out that one of the challenges is going to be to figure out which of the agents is causing which of the side effects. I'm going to give the researchers the benefit of the doubt and assume they have a plan for that, but the comment does show how complex this might be.

Of course, the benefits might outweigh the problems in the end. The combination could be the one that finally does the trick. We won't know until the trials run their course.

Another issue -- it might work well for another B Cell Lymphoma, but not Follicular Lymphoma. That's another goal of lots of phase I trials -- a kind of "throw it against the wall and see what sticks" approach. All of these 5 agents have shown some effectiveness in different types of lymphoma, including FL. So the trial is open to almost anyone with a B Cell Lymphoma. It could find that the combo works great for CLL and DLBCL, but not so much for Follicular.

Like with all trials, it will be a long time before we see the results of this one, but it's worth keeping an eye on.