ASH: New Treatments (Without Rituxan)

Today is the last day of the ASH conference, and I've been too busy to fully enjoy everything that has been happening. I've barely been on Twitter lately, and that's where I get a lot of my ASH news. So I'm behind on reporting what's been happening there.

Before the ASH meeting begins, I get my information by looking at the abstracts to see what kind of Follicular Lymphoma research is being presented. Once the meeting starts, I get press releases and news stories about some of the more exciting presentations. Pharmaceutical companies and universities and hospitals like to brag about their good work. And I like to read it.

So I want to look at some of the good stuff that's been coming out of ASH, but maybe not in as much detail as usual. So here's a good excuse to do that -- a comment from reader Shelly from a couple of days ago:

Bob,
Are you finding any new info on "other" treatments that are showing PFS in patients that DON'T involve Rituxan??? Especially for relapsed.
Shelly

Thanks for the comment, Shelly. Yes, there are some other treatments that don't involve Rituxan. And some of them have been talked about at ASH this year.

Rituxan is kind of a miracle treatment. Overall Survival has increased for FL patients in the last 20 years or so, which is about how long Rituxan has been around. Rituxan seems to make other treatments better, which is why it's almost always included with things like CHOP or Bendamustine. And newer treatments are often tested in trials as part of combinations, very often with Rituxan as a part of the combo.

But some people have allergic reactions to it, and some have used it a few times and it no longer works for them. So Shelly's question about new treatments that don't involve Rituxan makes some sense.

Here are some that have been talked about at ASH this year:

• In a phase 2 clinical trial, a treatment called G100 showed some success when combined with another called Pembrolizumab for relapsed/refractory patients. G100 is an immunotherapy that works on cancer cells to make them more receptive to the immune system. The G100 is injected into the tumor, where it reaches the cancer cells. Pembrolizumab is also known as Keytruda. It goers after the PD-1 receptor on lymphoma cells, and turns of the signal that keeps the cell from dying. In this trial, the combo had a PFS of just under a year (so far). the combo had an Overall Response Rate of 46%, and kept the disease under control for 92% of patients.
• In a phase 1 trial, a treatment called Mosunetuzumab showed a lot of promise. Mosunetuzumab is another immunotherapy -- it activates an immune cell called a T cell to go after the B cells that are causing the lymphoma. In patients with relapsed/refractory FL, the Response rate was 69%, with a 38% Complete Response. This is a phase 1 trial, so it was fairly small, but the treatment does get people excited.
• Another treatment, REGN1979, also showed lots of promise. Like Mosunetuzumab, REGN1979 is bispecific, meaning it can attach itself to two different targets, a T cell and a B cell. REGN1979 was tested in a very small phase 1 study of just 10 relapsed/refractory FL patients, all of them showed a response, with 8 of the 10 showing a Complete Response. The news was good enough to have the developers want to move on to a larger phase 2 trial.

There are more, but that's a good answer to Shelly's question -- yes, there are options that don't involve Rituxan.

A few important things to keep in mind:

First, I'm not a doctor. Talk to an oncologist about treatment options. But take all of this as reason for hope that we will have some good options in the future. (There are some really exciting things happening with immunotherapy.)

Second, remember that a lot of what happens at ASH and other oncology meetings involve treatments in clinical trials. That means they are still being developed and tested. They show promise, but they haven't been approved. It's not uncommon for something to do really well in a phase 2 trial and then not as well in a larger phase 3 trial when it gets tested on more patients. Be hopeful, but be realistic.

Finally, the only way for new treatments to be tested and then approved is if patients sign up for clinical trials. There are a decent number of options already approved for Follicular Lymphoma, but if you do need treatment, talk to your oncologist about clinical trial options, or get a second opinion from someone who knows about them. It may help you, and it will certainly help the rest of us.

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Once ASH is over, there will be lots of experts talking about what excited them most. I'll keep an eye out for those articles and videos, and pass along the good stuff.