Copanlisib for Follicular Lymphoma

A couple of Copanlisib-related items have come across my screen in the last few days, so I thought I'd share.

First, to remind you (since Copanlisib hasn't been in the news much lately, from what I have seen):

Copanlisib (also known as Aliqopa) is a PI3K inhibitor. PI3K is short for phosphatidylinositol-3-kinase, which is an enzyme that cancer cells depend on to grow and live. By inhibiting it, or stopping it, cancer cells don't get the signal that they should stay alive, and so they die. There are a few PI3K inhibitors approved for FL, but Copanlisib is thought to be better in one way -- it works on two of the three different forms of PI3K in the body (others only work on one of them). It has been approved by the FDA for relapsed FL patients who have tried at least two other treatments.

As I said, it's not in the news much lately, though it usually gets mentioned by name when lymphoma experts talk about non-chemotherapy treatments and the future of Follicular Lymphoma. (Search this blog and you'll see what I mean.)

The first thing that came around this week was an article from the journal Cancer Management and Research called "Copanlisib in the Treatment of Relapsed Follicular Lymphoma: Utility and Experience from the Clinic," written by Dr. Ayushi Chauhan and Dr. Bruce Cheson. (If you've been reading for a while, you know how much I enjoy Dr. Cheson's work.)

The article isn't describing new research. It's more one of those "here's where we are with things" articles.

Still, it's very helpful in that way. 

Copanlisib was approved by the FDA after only a phase 2 clinical trial, so it is currently in several phase 3 trials. These trials are looking at Copanlisib on its own, with others looking at it in combination with other treatment.

Interestingly, one of the other studies that the authors mention says that there is some evidence that Copanlisib is less effective due to insulin feedback. The treatment may set off a reaction that uses insulin to start the PI3K enyzmes that Copanlisib has inhibited, so slowing down insulin production during treatment may help it be more effective. One way of doing this might be through a keto diet, which I know a lot of people are interested in hearing more about. 

[But let me be very clear -- this article is not saying that a keto diet will stop, cure, or prevent cancer. It is being studied as a way of making one particular treatment more effective, and even that is just a theory. Don't stop eating bread because you think it will cure your cancer. There's no evidence of that. Talk to your doctor about your diet if you have questions.]

The rest of the article talks about the best uses for Copanlisib (it's a useful treatment for patients who have already tried two things and might get some use out of a different approach), and its future (like those trials that use it in combination with other treatments).

Which brings me to the second item that came across my screen recently: a quick video from Targeted Oncology featuring Dr. Mark J. Roschewski, who makes very quick mention of a different trial, this one a phase 2 trial that looks at Copanlisib with Rituxan in FL patients that have not yet had a treatment. I think this is probably part of a larger series of videos with Dr. Roschewski, but he is excited about this trial. So far, he says, every patient in it has had a response of some kind, with fairly quick reduction in the size of tumors. 

That's exciting, especially since the FDA approval was for relapsed FL. Good to see that it has some use in untreated FL, too. Options are good.

My guess is we'll see some of the results of these trials at ASCO in June. I look forward to it. (I'm happy about anything, really, that will get me through this winter and spring.)

More soon. Stay safe.