The FDA has approved a Rituxan biosimilar, called CT-P10 or Truxima. The approval is for some B Cell Lymphomas, including Follicular Lymphoma.
It's a potentially big deal.
A biosimilar is kind of like a generic drug. Generics are a little easier to make. A drug is a chemical compound, so once you figure of the chemistry, you have a recipe to follow. A biosimilar is harder, because it's not a chemical compound, but a biological agent -- something that comes from a living thing. Copying it is a lot harder.
Think of it this way -- making a generic drug is like following the recipe to make a cake. Making a biosimilar is like trying to figure out how to get the eggs when you don't have any chickens -- just an egg that you need to make a copy of.
Finding a Rituxan biosimilar has been a goal for a while, because Rituxan has been such an important part of most B Cell Lymphoma treatments for the last 20 years or so. When a treatment is approved, the company that developed it is given a period of time when they have exclusive rights to that treatment. But after a period of time, others are allowed to try to make copies (biosimilars, in Rituxan's case) and try to get the, approved.
The FDA was satisfied that Truxima will do the same job, with the same side effects, as Rituxan.
The reason this is a big deal for patients is that, like generic drugs, a biosimilar should lower the cost of treatment. When Rituxan was first created, it cost a lot of money to do the research and then to market the treatment. That exclusive period of time gave the company time to make up all those costs.
A biosimilar (or a generic) doesn't need to make up those research costs (it's already been developed), or the marketing costs (everyone knows how great Rituxan is). So they should be able to sell the treatment at a lower cost.
It will be interesting to see how popular it becomes. Insurance companies may like it, since it should lower costs. But will oncologists trust it? Old habits die hard, and they may just keep going with what they are used to.
Interestingly, just a few weeks ago, another company that is developing a Rituxan biosimilar decided not to go any further with it in the U.S. The FDA had asked for additional data in the spring before giving their approval, and the company decided that another biosimilar (probably Truxima) would be approved before they could get the FDA what it wanted.
I'll be watching closely for any reports of Truxima's use. If anyone out there is offered it during treatment, I'd love to hear how it goes.
Thursday, November 29, 2018
Sunday, November 25, 2018
ASH: Bendamustine and Transformation
Another ASH preview.
But first, I want to alert you Cancer Nerds to The Leonard List. Lymphoma researcher Dr. Jon Leonard has been creating the Leonard List for the past few years. He lists what he thinks are the 10 most significant or interesting lymphoma-related abstracts from ASH. He posts them one a day on Twitter in the days leading up to ASH. But this year he also discussed them in a podcast, which you can listen to here. (He added 5 more to the podcast, so you get a nice bonus there.)
So, basically, he does what I do, except more of them, and a broader look at lymphoma and not just FL, and he's an actual expert, unlike me. But otherwise, the same thing. (I really enjoy Dr. Leonard's stuff on Twitter. He gives his followers lots to think about.)
The Leonard List includes a few ASH abstracts that focus on Follicular Lymphoma research, or issues related to FL, including this one: "Frontline Therapy with Bendamustine and Rituximab (BR) in Follicular Lymphoma: Prognosis Among Patients with Progression of Disease By 24 Months (POD24) Is Poor with Majority Having Transformed Lymphoma."
The study was conducted by researchers in British Columbia, Canada, where Bendamustine + Rituxan is the standard treatment now for patients with symptomatic, advanced FL. Before that, the standard treatment for these patients was R-CVP. The researchers wanted to see if B-R has been more effective than R-CVP.
And the short answer is that, yes, it has been more effective, which is what they expected. With a median follow-up of just under 3 years, they found that the 2 year Event Free Survival for the 296 patients receiving B-R was 85%, and the Overall Survival was 92%. Looking back at 347 R-CVP patients, the EFS was 76%, though the OS was the same. So B-R was better in keeping patients from having problems, but not in keeping them alive any longer.
The more interesting information came when they looked at patients that had transformed to an aggressive lymphoma.
In the B-R group 28 patients (about 9%) transformed from FL to an aggressive lymphoma. The 2 year OS for this group was only 39%.
They also looked at POD24, or Progression of Disease within 24 months after treatment with immunochemotherapy. This is sometimes called EFS24, or Event Free Survival within 24 months of immunochemo. Same basic concept. These patients generally have a worse outcome than other FL patients whose disease does not return within 24 months. In the B-R group, POD24 occurred in 35 patients (about 12%). That's a little lower than the 20% of patients found in some other studied. However, those 35 included 27 of the patients who had transformed. Overall, the 2 year OS for POD24 patients was 38%.
Compare that to the R-CVP group. In that group there were 77 POD24 patients -- about 22%, with 31 of those 77 patients having transformed.
So what does all of this mean? Well, first of all, it confirms that FL patients whose disease does not progress within 24 months generally have a very good long-term prognosis. But it also confirms that patients who do progress have a poor prognosis. For patients taking B-R, the rate of transformation is about the same as with other treatments like R-CVP. However, the incidence of POD24 is lower -- Bendamustine might keep patients from having their disease return so quickly.
You can see that when you compare the POD24 numbers of the two treatments -- most of the POD24 patients for B-R also transformed. Transformation and POD24 are not always the same thing. So patients who have had POD24 happen haven't necessarily transformed.
The implication there is that B-R seems to do a good job of keeping advanced, asymptomatic FL from returning quickly. And for those that do have their FL return (as opposed to those who have transformed to something other than FL), "novel approahces specific to FL" might be used, instead of more aggressive treatments that are meant for transformed FL.
So while this probably isn't a "blockbuster," it does seem to give us some important information about that POD24/EFS24 population, and how it is (and is not) related to transformation. Plus, it made the Leonard List, so you know it's a good one.
More ASH stuff to come.
But first, I want to alert you Cancer Nerds to The Leonard List. Lymphoma researcher Dr. Jon Leonard has been creating the Leonard List for the past few years. He lists what he thinks are the 10 most significant or interesting lymphoma-related abstracts from ASH. He posts them one a day on Twitter in the days leading up to ASH. But this year he also discussed them in a podcast, which you can listen to here. (He added 5 more to the podcast, so you get a nice bonus there.)
So, basically, he does what I do, except more of them, and a broader look at lymphoma and not just FL, and he's an actual expert, unlike me. But otherwise, the same thing. (I really enjoy Dr. Leonard's stuff on Twitter. He gives his followers lots to think about.)
The Leonard List includes a few ASH abstracts that focus on Follicular Lymphoma research, or issues related to FL, including this one: "Frontline Therapy with Bendamustine and Rituximab (BR) in Follicular Lymphoma: Prognosis Among Patients with Progression of Disease By 24 Months (POD24) Is Poor with Majority Having Transformed Lymphoma."
The study was conducted by researchers in British Columbia, Canada, where Bendamustine + Rituxan is the standard treatment now for patients with symptomatic, advanced FL. Before that, the standard treatment for these patients was R-CVP. The researchers wanted to see if B-R has been more effective than R-CVP.
And the short answer is that, yes, it has been more effective, which is what they expected. With a median follow-up of just under 3 years, they found that the 2 year Event Free Survival for the 296 patients receiving B-R was 85%, and the Overall Survival was 92%. Looking back at 347 R-CVP patients, the EFS was 76%, though the OS was the same. So B-R was better in keeping patients from having problems, but not in keeping them alive any longer.
The more interesting information came when they looked at patients that had transformed to an aggressive lymphoma.
In the B-R group 28 patients (about 9%) transformed from FL to an aggressive lymphoma. The 2 year OS for this group was only 39%.
They also looked at POD24, or Progression of Disease within 24 months after treatment with immunochemotherapy. This is sometimes called EFS24, or Event Free Survival within 24 months of immunochemo. Same basic concept. These patients generally have a worse outcome than other FL patients whose disease does not return within 24 months. In the B-R group, POD24 occurred in 35 patients (about 12%). That's a little lower than the 20% of patients found in some other studied. However, those 35 included 27 of the patients who had transformed. Overall, the 2 year OS for POD24 patients was 38%.
Compare that to the R-CVP group. In that group there were 77 POD24 patients -- about 22%, with 31 of those 77 patients having transformed.
So what does all of this mean? Well, first of all, it confirms that FL patients whose disease does not progress within 24 months generally have a very good long-term prognosis. But it also confirms that patients who do progress have a poor prognosis. For patients taking B-R, the rate of transformation is about the same as with other treatments like R-CVP. However, the incidence of POD24 is lower -- Bendamustine might keep patients from having their disease return so quickly.
You can see that when you compare the POD24 numbers of the two treatments -- most of the POD24 patients for B-R also transformed. Transformation and POD24 are not always the same thing. So patients who have had POD24 happen haven't necessarily transformed.
The implication there is that B-R seems to do a good job of keeping advanced, asymptomatic FL from returning quickly. And for those that do have their FL return (as opposed to those who have transformed to something other than FL), "novel approahces specific to FL" might be used, instead of more aggressive treatments that are meant for transformed FL.
So while this probably isn't a "blockbuster," it does seem to give us some important information about that POD24/EFS24 population, and how it is (and is not) related to transformation. Plus, it made the Leonard List, so you know it's a good one.
More ASH stuff to come.
Tuesday, November 20, 2018
ASH: Rituxan Maintenance
I am very, very slowly working my way through the ASH abstracts.
I don't think this is going to be a big year for Follicular Lymphoma. Nothing that I can see as challenging what we know. I could be wrong, of course. Sometimes something happens during a conference that hadn't been obvious in the abstract, and there's only a lot of chatter online about it after the conference is over.
As always, it will be interesting to see what kind of press releases and announcements happen during and after the conference to see who's bragging about their work.
But from I can see, there's a lot of new treatments that are small improvements over what we have, or new studies on controversial topics that don't really resolve the controversy.
The first one to catch my eye is one of those "controversy" topics.
Rituxan Maintenance has been controversial for as long as I've been reading about it.
The controversy is usually over whether or not it's worth it. Some studies say it prolongs Progression Free Survival, and others say it doesn't. Some say it causes Rituxan to stop working, or to raise the risk of infections. Others say the opposite.
At this year's ASH, there is a study that looks at long-term and short-term use of Rituxan Maintenance. It's called "Rituximab Maintenance Treatment for a Maximum of 5 Years in Follicular Lymphoma: Final Results of the Randomized Phase III Trial SAKK 35/03."
This study work on the assumption that Rituxan Maintenance is a good thing. Instead of comparing a group of people on Maintenance to a group of people who didn't have it, it looks at a group of patients that had short-term Maintenance (6 months) and one that had it long-term (5 years).
They looked at 165 patients, half in each group. All of the patients had 4 weekly rounds of Rituxan. If the patient had a Partial or Complete Response, they were moved into one of the two Maintenance groups. The patients were followed for a median of 10 years.
What they found was that, even after 10 years, there was no significant difference between the two groups in Event Free Survival, Progression Free Survival, or Overall Survival.
The implication is that getting Rituxan Maintenance for a very long time doesn't help much. It ends up costing a lot more, and potentially causing some of the problems that other studies have shown it to cause.
From what I've read, two years seems to be the most common length for Maintenance. (I don't have any data to back that up -- just my sense from reading a lot). If that's the case, then even two years seems like it could be more than necessary.
One thing that I found especially interesting in the study is that it looked at Rituxan as the primary treatment before the Maintenance. Some patients hadn't had any treatment at all, some had chemotherapy before this study, and some may have had other treatments. But when I mentioned Maintenance to Dr. R so many years ago, he said there wasn't really a benefit to following just Rituxan with Maintenance. Any benefit seemed to come from following R+chemo with Maintenance. I don't know off hand if there are any studies that would show that there is a benefit now, but this study seems to be working on the assumption that there is.
The big picture, though, is that, like pretty much every other study of Rituxan Maintenance, there isn't going to be a final answer that comes out of this.
The best thing you can do it have a talk with your doctor and decide what's best for you.
More ASH to come.
I don't think this is going to be a big year for Follicular Lymphoma. Nothing that I can see as challenging what we know. I could be wrong, of course. Sometimes something happens during a conference that hadn't been obvious in the abstract, and there's only a lot of chatter online about it after the conference is over.
As always, it will be interesting to see what kind of press releases and announcements happen during and after the conference to see who's bragging about their work.
But from I can see, there's a lot of new treatments that are small improvements over what we have, or new studies on controversial topics that don't really resolve the controversy.
The first one to catch my eye is one of those "controversy" topics.
Rituxan Maintenance has been controversial for as long as I've been reading about it.
The controversy is usually over whether or not it's worth it. Some studies say it prolongs Progression Free Survival, and others say it doesn't. Some say it causes Rituxan to stop working, or to raise the risk of infections. Others say the opposite.
At this year's ASH, there is a study that looks at long-term and short-term use of Rituxan Maintenance. It's called "Rituximab Maintenance Treatment for a Maximum of 5 Years in Follicular Lymphoma: Final Results of the Randomized Phase III Trial SAKK 35/03."
This study work on the assumption that Rituxan Maintenance is a good thing. Instead of comparing a group of people on Maintenance to a group of people who didn't have it, it looks at a group of patients that had short-term Maintenance (6 months) and one that had it long-term (5 years).
They looked at 165 patients, half in each group. All of the patients had 4 weekly rounds of Rituxan. If the patient had a Partial or Complete Response, they were moved into one of the two Maintenance groups. The patients were followed for a median of 10 years.
What they found was that, even after 10 years, there was no significant difference between the two groups in Event Free Survival, Progression Free Survival, or Overall Survival.
The implication is that getting Rituxan Maintenance for a very long time doesn't help much. It ends up costing a lot more, and potentially causing some of the problems that other studies have shown it to cause.
From what I've read, two years seems to be the most common length for Maintenance. (I don't have any data to back that up -- just my sense from reading a lot). If that's the case, then even two years seems like it could be more than necessary.
One thing that I found especially interesting in the study is that it looked at Rituxan as the primary treatment before the Maintenance. Some patients hadn't had any treatment at all, some had chemotherapy before this study, and some may have had other treatments. But when I mentioned Maintenance to Dr. R so many years ago, he said there wasn't really a benefit to following just Rituxan with Maintenance. Any benefit seemed to come from following R+chemo with Maintenance. I don't know off hand if there are any studies that would show that there is a benefit now, but this study seems to be working on the assumption that there is.
The big picture, though, is that, like pretty much every other study of Rituxan Maintenance, there isn't going to be a final answer that comes out of this.
The best thing you can do it have a talk with your doctor and decide what's best for you.
More ASH to come.
Thursday, November 15, 2018
New Oncologist!
I finally have a new oncologist. And if you saw that exclamation point in the title and guessed that I was happy about it, you would be correct.
Let me remind you about the strange and sad saga of trying to find an oncologist.
When I was first diagnosed, I was assigned to Dr. R. I was very fond of him. He was young, which I liked -- I think younger doctors are more sympathetic because they haven't had time to push their emotions away yet. He and I got along great. He was smart and up-to-date, and we talked about family and baseball and living in Boston. He guided me through watching and waiting, and again through treatment with Rituxan.
And then he left me. After about 6 years as my oncologist, he moved to a warmer climate to teach in a medical school. (I'm sure he's doing great in that job.)
I took the opportunity to switch offices. The research hospital near me has a bunch of satellite offices. I had been going to one about 30 minutes away to see Dr. R. There's another 10 minutes away from home, and I decided to go to that one instead.
My new oncologist was Dr. K. He is without question the worst doctor I've ever had. He didn't listen. He told me at the first appointment that he had Follicular Lymphoma patients who just wanted to come in every 6 months and then not think about it. I told him I was not that kind of patient, and that I spent a lot of time learning about my disease. He didn't listen. He gave me lectures about stuff I learned when I was 12 and when I tried to tell him I understood all of that (kindly, of course), he just talked over me.
The worst thing, though, was when he told me I needed a PET scan. When I asked why, he told me that blood work and the exam were fine, and everything looked normal. I asked why I needed a PET, then, since there was apparently no reason for one, and I was young and didn't need the radiation. He couldn't give me an answer, but he insisted on a PET.
I didn't schedule the PET, and I started looking for a new oncologist. Before I found one, I got a letter saying Dr K was retiring. I was happy about that. He seemed to me like he had given up.
I was assigned to Dr. V. And he was awesome. He did one day a week at the satellite office, and the rest of his time at the main hospital, teaching in the medical school and supervising clinical trials. At my first appointment, I asked him what excited him about lymphoma research. He went on for 20 minutes, talking about new treatments and trials he was involved in. I was smitten.
And then, the next time I saw him, he told me that he was leaving for his dream job at a a major cancer center and was leaving in a few months.
I was sad again.
I really loved seeing a lymphoma specialist, and I called the main hospital to try to get in with one. For some reason, I could not get the office to understand what I wanted. I got so frustrated that when they transferred my call back to the satellite office, I just accepted the appointment they gave me. It was a bad day.
The new oncologist turned out to be OK. He was a generalist, not a specialist. But a friend with multiple myeloma (another incurable blood cancer) was seeing this same oncologist, Dr. F, and liked him. So I was willing to give him a chance.
Five minutes into my first appointment with Dr. F, he told me he was retiring.
I would need a new oncologist. If you weren't keeping count, that would mean 5 oncologists in 4 years.
******************
I decided that this time, I wasn't going to mess around. Last week, I called the main hospital's hematology department and explained my situation. They told me they would need a referral from the satellite office. Don't know why -- it's the same hospital. But that's what they needed. they said it could take a few days.
I got a phone message Friday from Doris, and couldn't call back until Tuesday. Then I spent about 30 minutes explaining what I needed -- my onc had retired and wanted to see a specialist. They looked up my records and told me that, since I had already seen one of the doctors there, I would need to keep seeing him.
Who did they want me to see?
Why, Dr. K.
Yes, the one who wanted me to get a PET scan that I didn't need. The one who was supposed to have been retired.
I politely told them that I really would rather not see Dr. K.
After a little more wrangling (they hung up on me once and then transferred me to the satellite office again), I mentioned Doris' name. I think they were happy to have an excuse to get rid of me, because they told me Doris would call me back.
I waited two days, and no call.
So this morning, I called and asked for Doris.
They put me on hold for a few minutes until Doris was free. I could feel my blood pressure rising as I got ready for a fight. But when Doris came on, she was great. She said she had received the referral from the satellite office, and she would find an open appointment with a hematologist. She put me on hold for a minute, and then came back with a date, and an oncologist, Dr. H. I looked at my calendar.
"Yes, that date sound great," I said. "What time is the appointment?.....Hello?......Hello?" [click.]
They had cut me off again.
I called back right away, and they put me on hold again until Doris was free. I took the time to look up Dr. H on their website.
What I read got me very excited. He's young. He's a hematology specialist. He teaches in the medical school. He does research on quality of life issues.
And here's the best part, given that they wanted me to see Dr. K again. Dr. H does research that shows that PET scans are often ordered when they aren't necessary.
Doris came back and we finalized the appointment. I'll see him in about three weeks.
Now, I know there's a chance he won't be perfect. And I know that, given my track record, there's a chance that I'll see him once and then he'll leave for a new job.
But I feel good about things. He seems like he has the qualities and experience that are important to me. I'll find out for sure in a few weeks.
More importantly, I feel good for being persistent and making sure I got what I wanted. Some days, I get beaten down easily and accept things that I shouldn't.
This was the best cancer-related news I have gotten in months. It was a lift I really needed.
I'll let you know how things go.
Let me remind you about the strange and sad saga of trying to find an oncologist.
When I was first diagnosed, I was assigned to Dr. R. I was very fond of him. He was young, which I liked -- I think younger doctors are more sympathetic because they haven't had time to push their emotions away yet. He and I got along great. He was smart and up-to-date, and we talked about family and baseball and living in Boston. He guided me through watching and waiting, and again through treatment with Rituxan.
And then he left me. After about 6 years as my oncologist, he moved to a warmer climate to teach in a medical school. (I'm sure he's doing great in that job.)
I took the opportunity to switch offices. The research hospital near me has a bunch of satellite offices. I had been going to one about 30 minutes away to see Dr. R. There's another 10 minutes away from home, and I decided to go to that one instead.
My new oncologist was Dr. K. He is without question the worst doctor I've ever had. He didn't listen. He told me at the first appointment that he had Follicular Lymphoma patients who just wanted to come in every 6 months and then not think about it. I told him I was not that kind of patient, and that I spent a lot of time learning about my disease. He didn't listen. He gave me lectures about stuff I learned when I was 12 and when I tried to tell him I understood all of that (kindly, of course), he just talked over me.
The worst thing, though, was when he told me I needed a PET scan. When I asked why, he told me that blood work and the exam were fine, and everything looked normal. I asked why I needed a PET, then, since there was apparently no reason for one, and I was young and didn't need the radiation. He couldn't give me an answer, but he insisted on a PET.
I didn't schedule the PET, and I started looking for a new oncologist. Before I found one, I got a letter saying Dr K was retiring. I was happy about that. He seemed to me like he had given up.
I was assigned to Dr. V. And he was awesome. He did one day a week at the satellite office, and the rest of his time at the main hospital, teaching in the medical school and supervising clinical trials. At my first appointment, I asked him what excited him about lymphoma research. He went on for 20 minutes, talking about new treatments and trials he was involved in. I was smitten.
And then, the next time I saw him, he told me that he was leaving for his dream job at a a major cancer center and was leaving in a few months.
I was sad again.
I really loved seeing a lymphoma specialist, and I called the main hospital to try to get in with one. For some reason, I could not get the office to understand what I wanted. I got so frustrated that when they transferred my call back to the satellite office, I just accepted the appointment they gave me. It was a bad day.
The new oncologist turned out to be OK. He was a generalist, not a specialist. But a friend with multiple myeloma (another incurable blood cancer) was seeing this same oncologist, Dr. F, and liked him. So I was willing to give him a chance.
Five minutes into my first appointment with Dr. F, he told me he was retiring.
I would need a new oncologist. If you weren't keeping count, that would mean 5 oncologists in 4 years.
******************
I decided that this time, I wasn't going to mess around. Last week, I called the main hospital's hematology department and explained my situation. They told me they would need a referral from the satellite office. Don't know why -- it's the same hospital. But that's what they needed. they said it could take a few days.
I got a phone message Friday from Doris, and couldn't call back until Tuesday. Then I spent about 30 minutes explaining what I needed -- my onc had retired and wanted to see a specialist. They looked up my records and told me that, since I had already seen one of the doctors there, I would need to keep seeing him.
Who did they want me to see?
Why, Dr. K.
Yes, the one who wanted me to get a PET scan that I didn't need. The one who was supposed to have been retired.
I politely told them that I really would rather not see Dr. K.
After a little more wrangling (they hung up on me once and then transferred me to the satellite office again), I mentioned Doris' name. I think they were happy to have an excuse to get rid of me, because they told me Doris would call me back.
I waited two days, and no call.
So this morning, I called and asked for Doris.
They put me on hold for a few minutes until Doris was free. I could feel my blood pressure rising as I got ready for a fight. But when Doris came on, she was great. She said she had received the referral from the satellite office, and she would find an open appointment with a hematologist. She put me on hold for a minute, and then came back with a date, and an oncologist, Dr. H. I looked at my calendar.
"Yes, that date sound great," I said. "What time is the appointment?.....Hello?......Hello?" [click.]
They had cut me off again.
I called back right away, and they put me on hold again until Doris was free. I took the time to look up Dr. H on their website.
What I read got me very excited. He's young. He's a hematology specialist. He teaches in the medical school. He does research on quality of life issues.
And here's the best part, given that they wanted me to see Dr. K again. Dr. H does research that shows that PET scans are often ordered when they aren't necessary.
Doris came back and we finalized the appointment. I'll see him in about three weeks.
Now, I know there's a chance he won't be perfect. And I know that, given my track record, there's a chance that I'll see him once and then he'll leave for a new job.
But I feel good about things. He seems like he has the qualities and experience that are important to me. I'll find out for sure in a few weeks.
More importantly, I feel good for being persistent and making sure I got what I wanted. Some days, I get beaten down easily and accept things that I shouldn't.
This was the best cancer-related news I have gotten in months. It was a lift I really needed.
I'll let you know how things go.
Tuesday, November 13, 2018
Update and New Writing
Ugh. I'm still catching up on things -- no time to even look at the ASH abstracts.
A few things to share, though.
1) I'm still in the process of finding a new oncologist. It's been a nightmare. I hope to have everything fixed by tomorrow, with a new oncologist that I'm happy with, and a long story to tell you. I'm going for a sad tale with a happy ending. Wish me luck that it actually turns out that way.
2) I had a piece published in Lymphoma News Today a couple of weeks ago that I haven't shared yet. It's called "I Find Hope in Cancer-Themed Humor." This has always been true for me. I think it's a blessing that I can see the absurdity in life and not be sad about it. And goodness knows there is plenty of absurdity in the life of a cancer patient.
3) I also had a piece published yesterday on Blood-Cancer.com. It's called "Follicular Lymphoma: Strange Guilt." I have long talked about the importance of emotions in our lives as FL patients. For me, one of those emotions has been Guilt. I've learned to deal with it, but it's still kind of there all the time.
I'm hoping life will ease up a bit soon, and I can get back to the blog. Lots of good stuff to write about -- no time to do it.
More soon. Come back.
A few things to share, though.
1) I'm still in the process of finding a new oncologist. It's been a nightmare. I hope to have everything fixed by tomorrow, with a new oncologist that I'm happy with, and a long story to tell you. I'm going for a sad tale with a happy ending. Wish me luck that it actually turns out that way.
2) I had a piece published in Lymphoma News Today a couple of weeks ago that I haven't shared yet. It's called "I Find Hope in Cancer-Themed Humor." This has always been true for me. I think it's a blessing that I can see the absurdity in life and not be sad about it. And goodness knows there is plenty of absurdity in the life of a cancer patient.
3) I also had a piece published yesterday on Blood-Cancer.com. It's called "Follicular Lymphoma: Strange Guilt." I have long talked about the importance of emotions in our lives as FL patients. For me, one of those emotions has been Guilt. I've learned to deal with it, but it's still kind of there all the time.
I'm hoping life will ease up a bit soon, and I can get back to the blog. Lots of good stuff to write about -- no time to do it.
More soon. Come back.
Wednesday, November 7, 2018
Anti-CD47 Treatment for FL
The New England Journal of Medicine just published the article "CD47 Blockade by Hu5F9-G4 and Rituximab in Non-Hodgkin’s Lymphoma." It describes research that people are very excited about, and that could provide a new path for treating Follicular Lymphoma.
Some background first. The article describes a type of immunotherapy. There are lots of immunotherapy treatments out there already and in development, but they all involve getting the immune system to attack cancer cells. The immune system's job is to defend against outside invaders (like bacteria and viruses). That doesn't help against cancer cells. They aren't outsiders -- they are parts of our body that went from normal to abnormal.
Immunotherapy treatments work in one of two general ways -- either change the cancer cells to make them look like outsiders that the immune system knows to attack, or change immune cells to recognize the cancer cells as something that should be attacked and defended against.
For a treatment like CAR-T, the immune cells are changed.
In the treatment described in this article, it's the cancer cells that are changed.
The article describes a treatment called Hu5F9-G4. (You can tell this is a really early trial because the treatment doesn't have a cool name with a Z or an X in it yet.)
Hu5F9-G4 works by targeting the protein CD47, which sits on the surface of some cancer cells. CD47 is important because, as the descriptions of the research say, it gives a "don't eat me" signal to immune cells. But Hu5F9-G4 blocks that signal, so the cancer cells are vulnerable. When that happens, an immune cell called a macrophage can recognize it as an invader. The word "macrophage" comes from the Greek words "makros" and "phagein," which together mean "Big Eater." Macrophages eat the invaders.
[How did I do there, Ioannis? Is my Greek pretty good?]
This treatment also included Rituxan, which targets a different protein, CD20. So between the two agents, you have twice the chances of getting to the cancer cells.
Now, the article describes results from a phase 1b/2 clinical trial. A phase 1 trial will basically figure out how much of a treatment to give, and the phase 2 trial will give the treatment to a particular group that might benefit from it. Both phases usually involve a pretty small group of patients.
For this trial, there were just 22 patients, 15 with Diffuse Large B Cell Lymphoma, and 7 with Follicular Lymphoma. All of them were heavily pre-treated -- they had tried at least 2 other treatments, and as many as 10 treatments. And almost all of them were refractory to Rituxan (meaning it had stopped working).
And the results were good. 50% of patients had a response, with 36% of them having a Complete Response. The FL results were especially good, with 71% Overall Response and 43% Complete Response. After 8 months, 91% of the responses were still holding.
People are excited about this for a couple of reasons. First, getting macrophages involved is new -- it's a different type of immune cell that might be used to attack cancer. Second, it seems to work for some patients who aren't able to use Rituxan anymore.
But there are certainly some questions, too. It's a very small trial, as phases 1 and 2 trials tend to be. The treatment needs to be tested on a larger group of patients before we can get ourselves too excited.
But if nothing else, this is another path for researchers to follow. There are a bunch of anti-CD47 presentations at ASH this year, for lots of different blood cancer. That's promising.
Certainly another one to keep an eye on.
(And more on ASH coming soon.)
Some background first. The article describes a type of immunotherapy. There are lots of immunotherapy treatments out there already and in development, but they all involve getting the immune system to attack cancer cells. The immune system's job is to defend against outside invaders (like bacteria and viruses). That doesn't help against cancer cells. They aren't outsiders -- they are parts of our body that went from normal to abnormal.
Immunotherapy treatments work in one of two general ways -- either change the cancer cells to make them look like outsiders that the immune system knows to attack, or change immune cells to recognize the cancer cells as something that should be attacked and defended against.
For a treatment like CAR-T, the immune cells are changed.
In the treatment described in this article, it's the cancer cells that are changed.
The article describes a treatment called Hu5F9-G4. (You can tell this is a really early trial because the treatment doesn't have a cool name with a Z or an X in it yet.)
Hu5F9-G4 works by targeting the protein CD47, which sits on the surface of some cancer cells. CD47 is important because, as the descriptions of the research say, it gives a "don't eat me" signal to immune cells. But Hu5F9-G4 blocks that signal, so the cancer cells are vulnerable. When that happens, an immune cell called a macrophage can recognize it as an invader. The word "macrophage" comes from the Greek words "makros" and "phagein," which together mean "Big Eater." Macrophages eat the invaders.
[How did I do there, Ioannis? Is my Greek pretty good?]
This treatment also included Rituxan, which targets a different protein, CD20. So between the two agents, you have twice the chances of getting to the cancer cells.
Now, the article describes results from a phase 1b/2 clinical trial. A phase 1 trial will basically figure out how much of a treatment to give, and the phase 2 trial will give the treatment to a particular group that might benefit from it. Both phases usually involve a pretty small group of patients.
For this trial, there were just 22 patients, 15 with Diffuse Large B Cell Lymphoma, and 7 with Follicular Lymphoma. All of them were heavily pre-treated -- they had tried at least 2 other treatments, and as many as 10 treatments. And almost all of them were refractory to Rituxan (meaning it had stopped working).
And the results were good. 50% of patients had a response, with 36% of them having a Complete Response. The FL results were especially good, with 71% Overall Response and 43% Complete Response. After 8 months, 91% of the responses were still holding.
People are excited about this for a couple of reasons. First, getting macrophages involved is new -- it's a different type of immune cell that might be used to attack cancer. Second, it seems to work for some patients who aren't able to use Rituxan anymore.
But there are certainly some questions, too. It's a very small trial, as phases 1 and 2 trials tend to be. The treatment needs to be tested on a larger group of patients before we can get ourselves too excited.
But if nothing else, this is another path for researchers to follow. There are a bunch of anti-CD47 presentations at ASH this year, for lots of different blood cancer. That's promising.
Certainly another one to keep an eye on.
(And more on ASH coming soon.)
Saturday, November 3, 2018
ASH Abstracts
Ten days. I think this is the longest I've gone between blog posts since I started writing it.
Unfortunately, it's because my Dad died last week. He was diagnosed with lung cancer over the summer, and he'd been in hospice care for about 5 weeks. (Everyone wants to know if he smoked, and he did, but he quit over 25 years ago when his first grandchild was born.)
So the last 10 days or so have been taken up by family obligations, making up work that I've missed, and then just not really feeling like writing about cancer.
The good news (and you know I'm all about good news) is that the ASH abstracts came out on Wednesday.
ASH is the American Society of Hematology, the major organization for doctors who specialize in blood diseases, including lymphoma.
The abstracts are the short descriptions of the different sessions for their conference, which will be held at the beginning of December. Doctors who will go to the conference can read the short summaries and then decide which lectures or presentations to attend.
Every year at this time, I like to go through the abstracts for Follicular Lymphoma (there are 249 of them this year) and write about the ones that look interesting to me.
From what I can tell, there aren't really any big "blockbuster" presentations about FL this year, though I could be missing something. There will be some chatter in the next few weeks about ASH, and I'll keep an eye out for anything that people seem to be excited about. I'll also look out for the ones that won't get as much attention, but that I think are important, like research about Quality of Life and how drinking scotch will help you if you have FL.
(I didn't think there would really be anything about the benefits of scotch being presented at ASH, but I searched for it anyway. Nothing. And nothing for bourbon, either.)
So I'll pass along any interesting new research that I come across in the next couple of weeks.
(And thanks to Shelly, for checking in on me when I hadn't posted in a week, to make sure I was OK.)
Unfortunately, it's because my Dad died last week. He was diagnosed with lung cancer over the summer, and he'd been in hospice care for about 5 weeks. (Everyone wants to know if he smoked, and he did, but he quit over 25 years ago when his first grandchild was born.)
So the last 10 days or so have been taken up by family obligations, making up work that I've missed, and then just not really feeling like writing about cancer.
The good news (and you know I'm all about good news) is that the ASH abstracts came out on Wednesday.
ASH is the American Society of Hematology, the major organization for doctors who specialize in blood diseases, including lymphoma.
The abstracts are the short descriptions of the different sessions for their conference, which will be held at the beginning of December. Doctors who will go to the conference can read the short summaries and then decide which lectures or presentations to attend.
Every year at this time, I like to go through the abstracts for Follicular Lymphoma (there are 249 of them this year) and write about the ones that look interesting to me.
From what I can tell, there aren't really any big "blockbuster" presentations about FL this year, though I could be missing something. There will be some chatter in the next few weeks about ASH, and I'll keep an eye out for anything that people seem to be excited about. I'll also look out for the ones that won't get as much attention, but that I think are important, like research about Quality of Life and how drinking scotch will help you if you have FL.
(I didn't think there would really be anything about the benefits of scotch being presented at ASH, but I searched for it anyway. Nothing. And nothing for bourbon, either.)
So I'll pass along any interesting new research that I come across in the next couple of weeks.
(And thanks to Shelly, for checking in on me when I hadn't posted in a week, to make sure I was OK.)