Good News for Bispecific Mosunetuzumab

The maker of Mosunetuzumab, the bispecific, released news this week that their phase III clinical trial for Mosunetuzumab and Lenalidomide seems to be an improvement over R-Squared. I think I have received about 20 different notifications from Google Alerts about it. That's a decent indication that this is a big deal.

As you probably know, Mosunetuzumab is the first bispecific to be approved for treating Follicular Lymphoma. Bispecifics work because they have two parts. One targets a protein on the surface of the cancer cell (CD20) and the other targets a protein on an immune cell (CD3). By attaching to both, it brings the immune cell next to the cancer cell and allows the immune cell to eliminate it. 

The phase III clinical trial is called CELESTIMO. It's a two-arm randomized study, meaning the 400 or so patients in the trial are randomly given one of two treatments. So ne group received Mosunetuzumab + Lenalidomide, and the other received R-Squared (Rituxan + Lenalidomide, also known as Revlimid, which gives you the two Rs).

[I want to make a prediction here. Mosunetuzumab is also known as Lunsumio. This combination is going to end up being known as L-squared -- Lunsumio + Lenalidomide. If you're comparing it to R-Squared, this just seems inevitable. I'm all for it. I just wish this blogging program did a better job with superscripts so I wouldn't have to type out :Squared" all the time.]

The results of the CELESTIMO trial are very positive. The manufacturer says the Mosunetuzumab combination resulted in a higher PFS (Progression Free Survival) than the R-Squared, meaning it took longer for patients' disease to become get worse. The manufacturer also said there were no new side effects from combination, only those that were already known about from Mosunetuzumab and Lenalidomide separately.

The manufacturer didn't release any data to back all of this up. They said they will do that either at an upcoming medical conference or in a publication.

[Prediction #2: They'll release the results at ASH and it's going to be one of the major sessions, big enough to be held in the ballroom of the hotel. And then it will be published in the journal Blood just a few days later.]

It's a big deal, given R-Squared's history. The combination was approved in the U.S. in 2019, and it was seen as a major step forward. It was the first non-chemotherapy treatment that was shown to be as effective as traditional chemotherapy like R-CHOP or Bendamustine. Chemotherapy still has a place in FL treatment, but newer treatments are more targeted, doing less damage to healthy cells. (To be clear -- one big takeaway when R-Squared was approved was that it had different side effects than chemotherapy. Not better or worse, but different.)

So if a second non-chemotherapy treatment exists that better than both chemo and R-Squared, then that's a very big deal. We won't really know just how big a deal until the manufacturer releases the data that shows us how effective and how safe it really is.

It's also a big deal given all of the excitement that we saw over the summer from the EHA conference over a presentation on Epcoritamab and R-Squared. Epcoritamab is the second bispecific to be approved for FL, and it has been used in combination with several other treatments in different trials. I suspect the manufacturer of Mosunetuzumab released this news without any data because they wanted to remind people that Mosunetuzumab is still around and there is plenty to be excited about for their bispecific as well.

I'll keep an eye on this one. I'm pretty confident we'll get the data at ASH in a few months (though I'm also notoriously not good at predicting things.) 

More soon. I have to get a few more posts in while I can still use both arms. 

Seasonal Patterns of Cancer Diagnosis

Well, this post isn't about Follicular Lymphoma, but it's certainly about cancer. And not too complex. And with my bad shoulder, I'm trying to stay in the habit of writing, and "not too complex" is good for that. 

I saw an article this weekend called "Seasonal Patterns and Implications of Cancer Diagnosis Across Calendar Months," published in in JAMA Network Open. 

The objective of the research is pretty straightforward -- is there a month of the year that has more patients in the United States diagnosed with cancer than other months? And if so, why?

The answer is, yes, there is a month with more cancer diagnoses. It's January. This is, of course, the month when I was diagnosed.

The researchers looked at data from cancer registrations and found 30,184,124 cancer diagnoses between 2001 and 2019. (Hey, I was in there!)

They found that January was highest, with 8.81% of cancer diagnoses. Here's the full list:

January 8.81%

February 7.78%

March 8.51%

April 8.35%

May 8.44%

June 8.60%

July 8.17%

August 8.46%

September 7.98%

October 8.58%

November 7.85%

December 7.76% 

There isn't a huge difference between months, but enough to matter. There's a 1% difference between December and January, which is about 300,000 cancer diagnoses. And it's important to keep in mind that these numbers aren't about when people get cancer -- that is, when the disease begins -- but about when they are diagnosed -- when a doctor confirmed that they had it. That's important.

The other question is, why does this pattern exist?

The researchers can't say for sure, but a fairly simple explanation could be that there is lower clinical activity in December and higher in January because of the holidays. In the U.S., "the holidays" starts in late November with Thanksgiving and goes through January 1 with New Year's Day.  People are focused on parties, shopping, spending time with family. It's too happy a time to think about whatever symptoms might be showing up. 

It's also possible that "workforce and specialist availability" has an impact diagnostic timing. It's harder to get an appointment at some parts of the year. 

There are also insurance-related factors. In the U.S., we don't have a public insurance system like in Canada or the UK. It's a complicated system, where something like a "deductible" has an impact. That is, depending on the deductible level, a patient will have to pay for much of their care on their own before health insurance begins to pay. So diagnoses might come later in the year after a deductible level has been reached and some patients can finally afford it. 

And then there are things like awareness campaigns. October has a high number of diagnoses, partly because of an increase in breast cancer diagnoses. October, of course, is breast cancer awareness month. Summer sees a rise in some diagnoses of skin cancers like melanoma. Many people become more aware of skin cancer in the summer months, when they are wearing less clothing and spending more time in the sun.

For me, it seems like it was just coincidence, rather than some seasonal-related issue. I was dealing with health problems starting in June, and it was late November that I went to see a surgeon about the large lymph node near my hip. After some antibiotics didn't work, we scheduled a surgical biopsy, and the results didn't come through until January. I wasn't putting off my health because of the holidays. 

But I think the research makes an important point -- sometimes it's an outside factor that pushes us to take care of our health. It's an easy thing to put off, and I have had loved ones who waited too long to get a diagnosis because they were afraid of what they might find out. Their outcomes were not good, and I lost them much sooner than I wished.

So sometimes we should be the outside force. Not a holiday or an awareness campaign. Just a concerned individual who cares enough about someone to encourage them to see a doctor. 

I'll get back to the FL research soon. But this gives us some things to think about.  

 

 

 

 

I'm Kind of a Mess

I know it's been a week since I posted anything here. I've been dealing with some stuff.

I had an MRI this afternoon. Shoulder injury.

Last Thursday, after I finished my blog post, I went to a dog training class with my standard schnauzer. There was someone there with a 100 lb. German Shepherd, and the big dog really did not like my little dog. The big dog's owner commented on it a few times, how his dog really likes most dogs, but just doesn't like certain dogs, and mine seemed to be a one of them.

Which would be fine, except this dog owner also gets distracted easily, and at one point, his big dog broke away from him and ran at me and my little dog. (Don't worry! No dogs were harmed!). I moved to my left to put myself between the two dogs, but my dog moved to the right, pulling on the leash and twisting my arm. The big dog decided it didn't want any trouble after all and his owner eventually came and puled him away.

So I've been hurting for the last week or so. Everything is taking more time than I'd like it to. 

When I went to see the orthopedist a few days ago, he moved my arm around a lot, and had me try to move it on my own, and had me try to push against his arm in different ways, and mostly reacted to all of these things by saying, "Oh, that's not good." 

He suspects a bad tear of my rotator cuff, which is kind of what I figured, too (though I was hoping I'd lucky and it would just be a bad sprain).  I actually had a torn rotator cuff in my opposite shoulder about 12 years ago, so I know what to expect from here. Whether that's good or bad, I don't know. But there will be surgery, and weeks of recovery, and months of rehabilitation, if history is a guide. 

So, yeah, I'm kind of a mess. I'm looking back at the last year, and I'm not happy about it. I was in physical therapy for months because of a knee injury.  I hurt my back a few weeks ago and had to take a break from yoga. There's the whole MGUS thing. 

I remember reading a couple of years ago that our bodies go through large changes in our 40s and 60s. (I found the article! It's our mid-40s and early 60s.) So I'm ahead of the curve on both of those ages, with cancer at 40 and a bunch of other stuff before 60. My mom always told me I was very advanced, so there you have it. 

Before I finish, a little reflection on the MRI that I had today. It's been 12 years since I had one, and I really don't usually mind any kind of testing. I mean I don't look forward to the results, but I'm fine with scans or biopsies or shots or blood draws or whatever. But I was kind of anxious about this one for some reason. In the phone call to set up the appointment, and then in two online surgeries, I kept being asked about being claustrophobic. If you're not familiar with an MRI, you get fed into a small tube, so it's a very enclosed space. I remember 12 years ago being very squished in, so my injured shoulder had to be in an unnatural position, which was very painful, and I had to hold still for 30-45 minutes. It was not fun.

But this one was different. There was much more room in the tube -- I could lie flat -- and the whole process took less than 15 minutes. It was still awful, but not as bad as I had anticipated. 

I think about the advances in cancer treatment that have happened since then, too. It doesn't seem like it, but 12 years is a long time.  A whole lot has happened in the world of Follicular Lymphoma in that time.

As we were driving home, my wife said maybe there have been some shoulder surgery advances n that time, too, and I'll do some quicker healing. That would be wonderful. I will hold out hope.

Because hope is a good thing, maybe the best of things.  (Quoting Shawshank Redemption always makes me feel better.)

I'll keep you updated. And I'll try my best to get back to writing about Lymphoma research soon.

Take care.

 

 

Happy Lymphoma Awareness Month

If you're reading this blog, you're probably aware that this is Lymphoma Awareness Month. It's a good thing -- it's an opportunity for others to learn more about our disease. Lots of organizations are using the opportunity to do just that. If you follow the Follicular Lymphoma Foundation on social media, for example, you've seen their posts so far this month, highlighting symptoms in one, and questions that people have at diagnosis in another. Be sure to like them when you see them.They are good ways to have those posts show up on the feeds of your friends, followers, and connections. It's an easy way to spread awareness.

Almost every year, I make the comment that I really don't need an awareness month. I've been very aware of my Lymphoma for almost 19 years now. 

But it's a funny thing -- sometimes we're made aware of things whether we like it or not. 

Yesterday, I got a text and an email that there was a new letter in my Electronic Medical Records account. My first reaction was slight panic -- "Now what?" I asked myself.

I haven't had any appointments or tests or anything else in a couple of months.  What could one of my many healthcare providers need to tell me?

And what's up with it being a letter? I get the occasional message or result or note. But a letter? Is this 1857?

It turned to to be the very long set of notes from a genetic counselor that I spoke with a few weeks ago. I had put it out of my head.

If you aren't aware of this, a genetic counselor is a healthcare professional that provides advice about getting a genetic test to see if your DNA carries one or more genes that can cause certain cancers. The BACA gene is an example -- it can increase the risk of breast cancer. I have a family history of certain cancers that might have a genetic disposition. (Follicular Lymphoma is not one of them, as far as researchers know.)  If I choose, I can have a test that looks for those particular genes. And if it turns out that I have one, I can do things like be tested more earlier or more frequently, or in some cases, have surgery to remove non-vital organs that might be more prone to cancer.

As I said, I had the initial meeting with a counselor and then put it out of my head. I really don't know if I want to do it.

For one thing, I'm already so hyper aware of my own cancer history that I'm not sure it's necessary. I had a benign polyp on my last colonoscopy, so I'm getting tested in 7 years instead of 10. I see my oncologist twice a year. I see my skin doctor twice a year. I know every lump and bump on my body. I know when something doesn't feel right.

So it is the awareness worth it? I don't know.

Of course, the other reason to do this is because we pass on our genes to our children. Is it fair to them to not let them know if they carry a gene that increases risk? (There is never a guarantee that someone with a certain gene will get cancer.) Is it more fair to not tell them, so they don't have to live with the worry that I have experienced for 18 years, wondering if every lump and bum is cancerous? 

If I pass on my awareness, is that enough? Will they be vigilant enough to take care of themselves, knowing what I have been through?

I still don't know what I'll do about the genetic counseling. 

But I do know that awareness is a good thing. And it's worth celebrating the knowledge that there are tests available that can help us assess our risk. The questionnaire I filled out, and  the counselor, both asked if my relatives had been given genetic tests. Of course someone like my grandmother, who was born in 1907 and died in 1986, never had a genetic test. They weren't available.

And that's my point. We're living in a good time. Awareness is about hope. More knowledge might mean an earlier diagnosis and a life saved.

I hope you find something to celebrate this month. Treat yourself well. You deserve it.