ASCO Follow-Up: R-Squared

Well, ASCO is over, and there are 3 or 4 big stories about Follicular Lymphoma that people are talking about.

The biggest, based on what I have seen on Twitter and other places, is the RELEVANCE trial -- the comparison of R-squared and Immunochemotherapy.

I wrote about this a week ago. R-Squared (Rituxan + Revlimid/Lenalidomide), followed by Rituxan Maintenance, seemed to work as well as Rituxan + Chemo (R-CHOP, R-Bendamustine, or R-CVP), followed by R Maintenance. Both treatments had side effects, though they were different.

I thought it was interesting that the researchers remained fairly objective in their abstract, not crowing about the results, the way some abstracts do (whether justified or not). I was very curious about how the results would be talked about after the presentation, when more data would be presented.

I would say, overall, the reaction was very favorable toward R-Squared, though the Lymphoma community is keeping its excitement under control.

Dr. Nathan Fowler, who presented the data at ASCO, spoke about the results in a video for Lymphoma Hub. He sums things up by saying he is "hopeful" that they showed that a non-chemotherapy regiment can give the same results as traditional chemo.

Dr. Fowler is quoted in an ASH Clinical News article as saying “These results show that R², an immunomodulatory approach, is a potential first-line option for patients with FL." The article also says that Dr. Fowler added that "the survival data of this analysis was immature and requires longer follow-up. The reliance on physician’s choice of chemotherapy in the R-chemo arm also may have confounded the findings."

Targeted Oncology provided a similar quote from Dr. Fowler: "Rituximab/lenalidomide was not superior to rituximab/chemotherapy, based on mature CR/CRu analysis. It is very important to know, as we might expect, there are differences in safety profiles between arms," said Fowler, the lead investigator and an associate professor at The University of Texas MD Anderson Cancer Center. "These results show that lenalidomide/rituximab, which is a novel immunomodulatory approach, is a potential first-line option for patients with FL who require treatment."

You get the picture.

I like that both the researcher and the people reporting are not getting ahead of themselves with this. R-Squared has been talked about for a few years, with lots of Lymphoma Experts very excited about its potential. So it's good that they remain excited, but aren't ready to declare this success as definite just yet. We can be "hopeful" that the combo "could" have "potential" as a non-chemo option for Follicular Lymphoma patients.

So, what does this mean for us as patients?

At the moment, nothing. And that's a good thing.

As the ASH Clinical News article pointed out, the results are promising, but still early. The Survival numbers are good, and just about the same, but longer-term numbers would make an even better comparison, and I'm sure we'll see those soon.

And as that same article points out, the comparison between R-Squared and R-chemo is a little deceptive, since the R-chemo group had 3 possible chemo combos to choose from, and each individual patient's doctor in that group got to choose which chemo to give the patient. This messes with the results a little, since the treatment choice wasn't random, and the doctor could have (and probably should have) chosen the chemo that would work best for that patient.

So we wait again, this time to see what the folks running the trial will do next. If the R-Squared combo is submitted for approval as a front-line (first) treatment for FL, and it gets approved, then we'll have a whole new round of speculation about how many patients and doctors will opt for a non-chemo option over traditional chemo.

I'll certainly be watching to see where it goes from here.

More ASCO follow-ups coming soon.