ASCO Part 2: Non-Chemo Treatments for Follicular Lymphoma.

This weekend, ASCO continues its virtual conference, with the 2020 ASCO Virtual Education Program. I'm calling this ASCO Part 2.

(I really wanted to call it ASCO Part 2: Electric Bugaloo, but I don't know how many of you would get that reference, so never mind.)

As I'm sure you remember, the ASCO conference (from the American Society of Clinical Oncology) takes place every year in early June. This year, the conference was split in two, since it is al taking place online -- the Scientific Program happened in late May, and focused on clinical trial results and other scientific research. ASCO was very generous this year and allowed patient advocates to "attend" for free. I was able to look in on sessions for the first time (since I can't ever afford to attend the conference in person).

And since I was registered for the Scientific Program, I am able to the Virtual education Program, which takes place this weekend. While the Scientific Program focuses more on giving results of research, the Education Program is more about how oncologists can use all of that research to be better doctors. So while it has sessions that focus on things like how Bispecifics might change the way Non-Hodgkin's Lymphoma patients are treated, it also has sessions on the specific cultural needs of cancer patients who serve in the military, or how COVID-19 is changing cancer care practices, or how to better care for LGBTQ cancer patients and survivors, or how financial toxicity can affect patient choices.

So while the sessions are focused on helping oncologists become better doctors, I can already see a bunch of sessions that look fascinating to me, even if they don't affect me directly. I'll try to share the ones that you might like, too, over the next few weeks.

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I'll start out with the only presentation that specifically addresses Follicular Lymphoma. (There are only 90 sessions for the whole program, and a bunch of those are speeches or award presentations, so it's no surprise that there is only one for FL.)

(Also, since this conference isn't presenting the results of new research, this presentation is more of a summary of previous research. Remember, the idea here is to educate oncologists, probably non-specialists who need a summary of research.)

The presentation is called "Chemotherapy-Free Approaches in Follicular Lymphoma and Mantle Cell Lymphoma." I'm including a link, though I don't know if you can access it without being registered for the conference.

The idea of the presentation is probably familiar to many of you (being patients who like to be well-informed). Traditionally, lymphomas have been treated with chemotherapy. And chemo still plays a big role in our treatment choices, with Bendamustine, CHOP, and CVP being very common. 

But more and more, researchers are focusing on non-chemotherapy treatments. Since traditional chemo kills some healthy cells as well as cancer cells, leading to a range of side effects, there is a preference for many newer treatments, which do a better job of targeting cancer cells and leaving healthy cells alone. There are still some side effects, but they are different from those that we might experience with chemotherapy. (Less hair loss, more nerve damage, for example.) We are likely at "maximum impact" from chemo -- what we have now is as good as it's going to get. Non-chemo treatments are the future.

And we do have several options.

For patients who are "treatment naive" (that is, who will be getting their first treatment), the options include Rituxin (which I received 10 years ago). But there are several others with a lot of promise, including R-Squared (Rituxan + Revlimid/Lenalidomide). Just a few weeks ago, updated research on R-Squared showed that it is effective for untreated FL patients. Other research on Lenalidomide + Obinutuzumab (a cousin of Rituxan) also shows promise.

There are a few more options for patients who have Relapsed/Refractory disease (they already had treatment, and it stopped working, or didn't work at all).  R-Squared is the one that seems to excite most oncologists. It's already been approved by the FDA. There's also the trio of inhibitors (Idelalisib, Copanlisib, and Duvelisib). Another, Umbralisib, is undergoing FDA review. And ME-401 is another inhibitor under review. While the inhibitors have had some success as individual agents, they tend to do better when they are combined with other things. Of course, that also means the chances are higher for more side effects. 

And finally, there's Tazemetostat, which was approved for Refractory/Relapsed FL patients with EZH2 mutations.  

The take-away from the session is that there are now chemo-free options for all Follicular Lymphoma patients, no matter where they are in their treatment life. 

One thing I noticed as I was creating the links is just how many of them have been in the news in the last few months. We are definitely in the middle of a real change in the way FL gets treated.

I can see an important issue for oncologists, though maybe it matters less in reality -- for many (most?) cancer patients, any treatment they get is "chemo." I don't know if it matters to them that Rituxan isn't technically chemotherapy, but maybe knowing the difference might also ease their anxiety a bit, if they see "chemo" as something scary. Understanding the distinction might also lead more patients to consider clinical trials.

As I said, I'll comment on some more of these ASCO 2 sessions in the next few weeks (I'm looking at a presentation on diet and another on CBD oil). There are some other Follicualr Lymphoma news items from the last week that could use commentary, too.

Stay tuned.