Before I get to another ASCO presentation, I want to provide a link to the webinar I helped with last week for the Follicular Lymphoma Foundation.
The webinar is called "FL Treatment Options: What You Need to Know." It features Professor Andrew Davies of the University Hospital Southampton in the UK, who did an amazing job of explaining the treatment options available to us in an easy-to-understand way, and Dr. Mitchell Smith, the Chief Medical Officer for the FLF, who asked great questions and found ways to connect what I was saying as a patient and what Prof. Davies had to tell us as a Lymphoma expert.
I really enjoyed doing it, getting to share my experiences as a patient. I really like the messages that the FLF tries to get across, especially the importance of being an informed patient who can have a good conversation with their oncologist and ask the right questions. We have a lot to be hopeful about.
The webinar is about an hour long. I hope you can find some time to watch it.
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Now, on to the ASCO abstract for today.
I was really interested in #7070 "Clinical and biological subtypes of follicular lymphoma revealed by tumor and immune cell states."
As you read more about Follicualr Lymphoma, one word that you see over and over is "heterogeneous," which basically means that there are lots of different types of FL. If you spend any time in an online group for FL patients, you'll see how this plays out. You'll have someone like me who could watch and wait for a couple of years and then have a very long response from just Rituxan, And you'll also encounter someone who had a very aggressive FL who needed traditional chemo and maybe several other treatments after that. And you'll have other patients with experiences somewhere in between.
This heterogeneity of the disease makes it a challenge to treat. Very often, patients don't know if a treatment will work until they've had the treatment. In an ideal world, we'd have a better sense of that before treatment began, perhaps by a biomarker. A biomarker is some biological component (maybe a certain protein on the cancer cell, for example) that would let the doctor know that a certain treatment is more likely to work, or maybe more likely to be aggressive or transform, allowing the doctor to at least narrow down the choices of treatment. We don't really have that yet.
Every now and then, someone proposes some kind of scheme for classifying Follicular Lymphoma into subtypes, allowing us to have a better sense of what we might expect. FL will always be heterogeneous -- that's unavoidable. But it would be great to more accurately categorize that heterogeneity.
This ASCO presentation is the latest attempt to do that. They try to create categories of FL based on characteristics of the cancer cells themselves, but also characteristics of other immune cells. They looked at several thousand samples of FL cells, and found four different subtypes of FL. It's kind of hard to distinguish the four types, and in some ways, the details don't really matter at this point. It will require a larger study to see what the real world implications are, and if this proposed scheme even holds up.
They do identfy two possible future targets for future treatments -- CREBBP (CRE-Binding Protein, which is involved in cell growth) and PRDM15 (a protein involved in differentiation, where an immature cells grows into a specific type of cell).
Will those targets result in new, effective treatments years from now? Will the subtypes hold up and help doctors make better treatment decisions? Hard to say, at least for now.
But what I find most interesting is what it all says about where we are right now. For all of the progress that has been made in developing new treatments, there is still so much that we don't know.
And I find that oddly comforting. If researchers said "Well, it looks like we've tried everything, and nothing works," that would be sad. But we're constantly getting new possibilities, learning more about FL, even when things don't work out as we'd hoped. Researchers will hit on something soon -- maybe not tomorrow, maybe years from now. But we're always moving forward. I find that really hopeful.
More ASCO stuff soon.
(And remember to watch that FLF webinar when you get a chance.)
1 comment:
Interesting, thank you. In this 2022 Blood article, my rare indolent NHL called Splenic Marginal Zone Lymphoma (SMZL) is also described as heterogenous and was divided into four subsets:
https://ashpublications.org/blood/article/139/5/732/477330/Genetic-and-phenotypic-attributes-of-splenic
"SMZL comprises 4 distinct genetically defined molecular clusters and 2 distinct phenotypically defined immune-microenvironment classes. The molecular-based nosology of SMZL can improve disease classification and discovery of novel biomarkers and therapeutic vulnerabilities."
I contacted Mayo clinic's specialist staff spearheading this study last week to ask if and when I can test for it, awaiting response. Like your FL peers, my SMZL peers can burn through various treatments until they find the one that works. This upfront classification testing has to be a better way to not only conserve our health, but also cut down on treatment costs. Let's hope testing becomes mainstream.
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