ASCO Follow-Up: Assessing Response in Follicular Lymphoma

The Journal of Clinical Pathways podcast this week featured Dr. Peter Martin, head of the Lymphoma Program at Weill Cornell Medical College in New York. He discusses a few sessions from the ASCO conference this summer, particularly the ones that focus on assessing response -- how we figure out whether a treatment worked.

You can listen to the brief (7 minutes or so) podcast, or read the transcript, by clicking here.

Dr. Martin first looks at the GALLIUM trial, and how researchers used PET scans to determine if the treatments they were studying (Rituxan + chemo vs. Obinutuzumab + chemo) worked. (I looked at this one, too. I always like when an expert thinks something was important that I thought was important Validates that sometimes I know what I think I know.) The PET scans helped doctors see if the patient had a complete metabolic response -- a much more detailed and accurate look at the treatment results than a CT scan. As Dr. Martin says, "As we're moving into an era where we're trying to predict who's likely to do well and who doesn't, it does appear that end‑of‑induction PET/CT scan may, in fact, do a fairly reasonable job of discriminating between those who are likely to do well and those who aren't."

Dr. Martin also addresses Bone Marrow Biopsies, a topic that lots of us are familiar with. (I hit on this topic, too.) BMBs are often required for clinical trials as a way of checking on how well a treatment worked. As he says, patients hate them, and doctors often discourage them, meaning patients don't go into clinical trials. So having a method that works well (like  PET scan) might help with clinical trial recruitment, too. 

And if we want new treatments, folks, we need clinical trials, and people to participate in them. Keep that in mind.

The last ASCO presentation he discusses was not one that I looked at. It examined PET scans in patients with Follicular Lymphoma grade 3b. Grade 3b is different from other types of FL, including 3a. It's often treated like an aggressive lymphoma, more like DLBCL than most FLs. PET scans helped identify bone marrow involvement, and could help identify a high-risk group of lymphoma patients.

So some nice commentary on the importance of PET scans in helping figure out how well a treatment has worked. There is some research that says a PET scan as a surveillance tool (using a scan in between treatments to see if treatment is needed) isn't always a good idea, but as a way of measuring treatment effectiveness, it can be very helpful.

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A quick word of sad news:

This week, we had to say goodbye to our dog Strudel. I only mention it because I know some of you have dogs, and Strudel actually made a few appearances in the blog over the years. She was almost 14. She was a good dog, despite the things I said about her.

She actually wrote a guest post a little more than a month after I started the blog.  Her sassiness came through even back then. It was a trait that stayed with her for her whole life.

I wrote about her when I wrote about cancer-sniffing dogs, too. Like the first dog trained to sniff cancer, Strudel was a standard schnauzer. However, she was not a cancer-sniffing dog, something that I resented (but I got over eventually).

I mentioned her again last summer, in a post about dogs and cancer. 

I'm going to resist the temptation to write more about her here, because I know I would go on for a very long time, telling stories.

Let's just leave it at this: she was a good dog with a lot of personality. There's a big hole in our house, and in our hearts, this week.