ASCO!

Well, it's finally here -- ASCO (the American Society of Clinical Oncology) annual meeting starts tomorrow and goes through early next week. I look forward to ASCO every year, because it's the largest gathering of oncologists in the U.S., and so many researchers and pharma companies wait for ASCO to make big announcements and show off great research results. Every now and then, one of the very exciting bits of news involves Follicualr Lymphoma. (But not often -- cancer research is usually about small steps forward rather than giant leaps that make the news.)

This year's conference is a little different. For one thing, it's back in person -- thousands of oncologists will travel to Chicago to talk to one another about cancer research. That didn't happen in 2020 and 2021, when the conference was virtual. 

One nice thing about the virtual meetings was that ASCO allowed patient advocates (like me) to register for free, so we could sit in on virtual presentations the same way that all of those oncologists were doing. It was a pretty wonderful thing -- not a lot of medical conferences allow advocates in, especially for free. (And even then, they define "advocate" in a particular way, usually as someone who works for an organization that helps cancer patients.) So, I have lots of love for ASCO. Even this year, with an in-person meeting, ASCO let me register for free for all of the online parts of the meeting. I won't get to see everything live, the way I would if I was there, but I do get to see a lot, and I'll be able to watch recordings after they were presented live. 

The other thing that's different this year is that abstracts were not released until just a couple of days ago. Usually, I can see the abstracts (the summaries of the presentations) a couple of weeks before the conference starts, and I can start writing about them then. (Look back at the May/June posts from the last 5 or 6 years and you'll see what I mean.) This year, there was very little time for that. I'm just getting around to it now.

So, as usual, over the next few weeks I'll write about some of the ASCO presentations that catch my eye. Maybe not the most important ones, but the ones that I think are most interesting or promising. (As I like to remind you all, I am not a doctor or a cancer researcher, I'm just a Cancer Nerd -- a patient who reads a lot.) And because this is such a large conference, there will be lots of commentary over the next few weeks from the actual experts, so I'll report on that, too.

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So one quick look at one of the abstracts for research on Follicular Lymphoma: this one is called "Efficacy and safety of zandelisib administered by intermittent dosing (ID) in patients with relapsed or refractory (R/R) follicular lymphoma (FL): Primary analysis of the global phase 2 study TIDAL."

It caught my eye mostly because I'm seeing it on the same day that I've seen a whole lot of news articles about the FDA officially removing approval for Umbralisib. 

Umbralisib is, of course, one of the PI3K inhibitors that will no longer be available to Follicular Lymphoma patients, whether because of an FDA decision or a decision by the company that makes them. (I've already written a lot about this in the last few months, as you probably know.)

Zandelisib came along at an unlucky time, ready to release results just as all of this PI3K bad news was happening. But Zandelisib is also different from other PI3K inhibitors in some ways, as this presentation shows.  One of the attractive things about some PI3K inhibitors was their oral administration -- instead of sitting in a treatment room for hours, you could take a pill (or two) every day. Unfortunately, a pill a day potentially led to some of the safety issues that had the FDA concerned. Zandelisib tried to deal with that through "intermittent dosing," taking time off from the pill to let the immune system recover. A small phase 1 study showed promise -- the convenience of a pill at home with decent safety and good effectiveness.

The ASCO study reports on a larger phase 2 study. Results are good, and confirm what was shown in the phase 1 study. The Overall Response Rate was 70%, including a 35% Complete Response Rate. It's still early to determine how long the response lasted (which is usually a good sign -- more then half is needed to achieve a median). As for safety, results were OK. About 10% of patients had to drop out of the study due to side effects, and some patients had digestive system issues and blood count issues that were grade 3 (more serious).

The numbers are good enough to warrant more study, either for Zandelisib on its own or in combination (the abstract mentions a phase 3 study of Zandelisib plus Rituxan). 

It's still hard to say where the company will go with this. I hope they will continue. With other PI3K inhibitors dropping out, it seems like there is space for an inhibitor to take their place. It's still too soon to know how oncologists are treating the whole PI3K issue, though I've heard some saying they still believe there is a place for these inhibitors in FL treatment. We will see what the reaction is to this presentation, I guess, and go from there.

More ASCO news and comments to come over the next few weeks.