Two more press releases describing news coming out of this weekend's ASH conference.
The first is called "Fractionated 90Y-Ibritumomab Tiuxetan Effective as First-Line Therapy for Relapsed Follicular Lymphoma." 90Y-Ibritumomab is Zevalin, the RadioImmuno Therapy. The study showed that Zevalin was effective as a first-line treatment (that is, for Follicular NHL patients who not been treated before) -- as effective as chemotherapy. This is significant: Zevalin has already been approved as a second-line therapy, and then as a consolidation therapy (given immediately after chemo), but this is the first evidence that it is effective as a first treatment rather than some kind of follow-up. Furthermore, the study shows that Zevalin is effective for those with high tumor burden; previous research suggested that if the lymphoma was too far along, Zevalin wouldn't work.
The second study is called "Rituximab Dosing Schemes Prove Equal in Low-Burden FL." This one, in some ways, contradicts a study that I commented on a couple of days ago. This one says that Rituxan maintenance (giving doses of Rituxan every 6 months) is as effective as giving Rituxan only when necessary. Both strategies delayed the need for chemotherapy for just under 4 years. The study, though, and its implications are a little more nuanced than a comparison to that other study would suggest. First, it is pointed out that the maintenance group spent a lot more money on treatment than the other one. Second, there doesn't seem to be any difference in quality of life or stress level in these patients; both knew that Rituxan was coming at some point. Finally, and maybe most importantly, it provides evidence that perhaps watch-and-wait is no longer necessary, since Rituxan in either approach (maintenance or as-needed) provides more time until chemotherapy is necessary than W & W does. (I tend to think, though, that there will be a big chunk of doctors who will think that no therapy is still preferable to any amount of Rituxan, unless and until it's necessary.)
As I said last time, none of these studies is The Big One, the answer to it all. In fact, it just kind of muddies things even more. But I tend to think that more options, even muddied options, is better than fewer. Arrows in the quiver -- until The Big One comes along, I'm happy to have more options.
Tuesday, December 13, 2011
Sunday, December 11, 2011
More from ASH
I recently posted several comments about studies that were going to be presented at this year's ASH (American Society of Hematology) conference. These were from the abstracts published before the conference took place.
Well, the conference is actually going on now, so there is more news coming out about some promising treatments and trials, particularly related to Follicular NHL. Two press releases to share:
The first discusses a study that shows that as-needed treatment is better than maintenance treatment for asymptomatic Follicular NHL patients. This seems to shed some light on a recent controversy (though I suspect it's really just going to muddy things up some more): Right now, there seems to be a trend toward giving Rituxan maintenance to patients who have had some treatment, whether straight Rituxan, chemo + Rituxan, or some other treatment. With R-maintenance, patients are given 4 rounds of Rituxan every six months, with the idea that it will help clean up any residual cancer that develops. However, this study seems to show that just waiting until further treatment is needed provides just as much success. So doing nothing until it's necessary spares the patient the time, pain, and cost of more treatment.
I have a small stake in this study, having asked about R-maintenance after my treatment. Dr. R suggested that it would be better to hold off ("Do no harm" is his guiding principle), and I was persuaded to go along with that recommendation. I'd really like to see one side or the other be shown to be definitive, but I'm battle-worn enough to know that there are no easy answers with fNHL.
The other noteworthy press release I came across today had to do with an alternative to Rituxan called GA101, or Obinutuzumab. Like Rituxan, it's a monoclonal antibody, and it also targets the CD20 protein on the surface of the cancer cell, but unlike Rituxan, it is made from human (not mouse) cells, and so is thought to have fewer potential side effects. This press release (scroll down; it's the third study discussed) provides some numbers from a small-ish (175 patient) phase 2 study, the first that compared the two directly. These are some (I think) small improvements with the GA101. We'll see if, ultimately, the FDA thinks the difference is big enough. If nothing else, it will be one more weapon in the arsenal.
I'll keep looking for more good news to come out of ASH. The dust will clear in the next few days (dust-ASH...funny....), and we'll see more bragging press releases soon, I'm sure.
Well, the conference is actually going on now, so there is more news coming out about some promising treatments and trials, particularly related to Follicular NHL. Two press releases to share:
The first discusses a study that shows that as-needed treatment is better than maintenance treatment for asymptomatic Follicular NHL patients. This seems to shed some light on a recent controversy (though I suspect it's really just going to muddy things up some more): Right now, there seems to be a trend toward giving Rituxan maintenance to patients who have had some treatment, whether straight Rituxan, chemo + Rituxan, or some other treatment. With R-maintenance, patients are given 4 rounds of Rituxan every six months, with the idea that it will help clean up any residual cancer that develops. However, this study seems to show that just waiting until further treatment is needed provides just as much success. So doing nothing until it's necessary spares the patient the time, pain, and cost of more treatment.
I have a small stake in this study, having asked about R-maintenance after my treatment. Dr. R suggested that it would be better to hold off ("Do no harm" is his guiding principle), and I was persuaded to go along with that recommendation. I'd really like to see one side or the other be shown to be definitive, but I'm battle-worn enough to know that there are no easy answers with fNHL.
The other noteworthy press release I came across today had to do with an alternative to Rituxan called GA101, or Obinutuzumab. Like Rituxan, it's a monoclonal antibody, and it also targets the CD20 protein on the surface of the cancer cell, but unlike Rituxan, it is made from human (not mouse) cells, and so is thought to have fewer potential side effects. This press release (scroll down; it's the third study discussed) provides some numbers from a small-ish (175 patient) phase 2 study, the first that compared the two directly. These are some (I think) small improvements with the GA101. We'll see if, ultimately, the FDA thinks the difference is big enough. If nothing else, it will be one more weapon in the arsenal.
I'll keep looking for more good news to come out of ASH. The dust will clear in the next few days (dust-ASH...funny....), and we'll see more bragging press releases soon, I'm sure.
Friday, December 9, 2011
More on Personalization
I write about personalization a lot, partly because it's in the "cancer news" cycle a lot, but also because it's pretty exciting.
The latest: a study from Weill-Cornell (reported on their very excellent blog, "New Developments in Lymphoma," on a collaboration with Sloan-Kettering and the National Cancer Institute.The research team found a compound called PU-H71 that can reveal the pathways in cells that have been changed, resulting in cancer. Once the pathways have been revealed, treatments can be created that will target them. That's where the personalization comes in. Each individual's cancer is a little different, so revealing the individual pathways will help uncover those individual differences.
The original research is published in the journal Nature Chemical Biology, in an article called "Affinity-Based Proteomics Reveal Cancer-Specific Networks Coordinated by Hsp90."
One more step in the right direction.
The latest: a study from Weill-Cornell (reported on their very excellent blog, "New Developments in Lymphoma," on a collaboration with Sloan-Kettering and the National Cancer Institute.The research team found a compound called PU-H71 that can reveal the pathways in cells that have been changed, resulting in cancer. Once the pathways have been revealed, treatments can be created that will target them. That's where the personalization comes in. Each individual's cancer is a little different, so revealing the individual pathways will help uncover those individual differences.
The original research is published in the journal Nature Chemical Biology, in an article called "Affinity-Based Proteomics Reveal Cancer-Specific Networks Coordinated by Hsp90."
One more step in the right direction.
Tuesday, December 6, 2011
Bone Marrow Donor Payments
I saw a very quick story about this online a few days ago, and haven't seen much about it since: a federal appeals court ruled that some bone marrow donors can be paid for their donations. Because bone marrow transplants are a significant part of the treatment package for lymphoma (and other cancer) patients, this is a pretty significant change.
It is against the law to sell or be paid for an organ donation. Up until now, the law applied to bone marrow as well other organs. This is because bone marrow transplants at one time involved aspiration -- sticking a very large needle into the donor's hip bone and sucking out the marrow. (As far as I know, it's the same procedure as a bone marrow biopsy, which I've had done. It's not fun.)
These days, most bone marrow transplants are not done this way. They aren't even called that name anymore; now they're stem cell transplants, and they're done very differently. The donor is given medication that causes the bone marrow to release stem cells (immature blood cells) into the blood stream, where they are collected (similar to the way someone donates blood), and eventually used for stem cell transplants for cancer patients and others.
The court ruled that this newer procedure is basically the same technology as donating blood, and since blood donors can get paid, then stem cell donors should be able to get paid as well. (The older, aspiration bone marrow donation is still invasive enough to have payments for donation remain illegal.)
Proponents say that this change will increase the pool of donors. This is important because it is sometimes very hard to find a bone marrow match for a transplant. Opponents, though, say that this might just cause more problems than it solves.
I've written about stem cell transplants before -- they represent a cure for many lymphoma patients. The patient is given heavy duty chemo, enough to wipe out their immune system, and the transplanted stem cells help jump start the immune system and keep the patient from getting a life-threatening illness. Donors might now be paid up to $3000 in the form of scholarships, housing allowance, or gift to charity.
I have mixed feelings about it. I can see how it might create problems. But I don't have to think too hard to imagine the frustration a cancer patient might feel because a donor match couldn't be found. (In fact, I know some folks in the support group who have been in that situation.) So I guess I'm thinking that anything that helps a cancer patient can't be bad.
***************************
On a related note: I heard about this change in the law again on a radio show this afternoon. The person explaining it all did a really good job, until the host asked her to explain how this could save people's lives. She said, "Oh, it can help lots of people. Leukemia victims--"
Grrrr.
I hate cancer patients being referred to as "victims." There's a helplessness that goes along with that word, and I don't like other people assuming that someone with cancer is helpless. Because sometimes it makes the patient feel helpless. And helplessness and victimization are about the loss of hope. And making people lose hope pisses me off.
And she was doing so well in the interview up to that point....
It is against the law to sell or be paid for an organ donation. Up until now, the law applied to bone marrow as well other organs. This is because bone marrow transplants at one time involved aspiration -- sticking a very large needle into the donor's hip bone and sucking out the marrow. (As far as I know, it's the same procedure as a bone marrow biopsy, which I've had done. It's not fun.)
These days, most bone marrow transplants are not done this way. They aren't even called that name anymore; now they're stem cell transplants, and they're done very differently. The donor is given medication that causes the bone marrow to release stem cells (immature blood cells) into the blood stream, where they are collected (similar to the way someone donates blood), and eventually used for stem cell transplants for cancer patients and others.
The court ruled that this newer procedure is basically the same technology as donating blood, and since blood donors can get paid, then stem cell donors should be able to get paid as well. (The older, aspiration bone marrow donation is still invasive enough to have payments for donation remain illegal.)
Proponents say that this change will increase the pool of donors. This is important because it is sometimes very hard to find a bone marrow match for a transplant. Opponents, though, say that this might just cause more problems than it solves.
I've written about stem cell transplants before -- they represent a cure for many lymphoma patients. The patient is given heavy duty chemo, enough to wipe out their immune system, and the transplanted stem cells help jump start the immune system and keep the patient from getting a life-threatening illness. Donors might now be paid up to $3000 in the form of scholarships, housing allowance, or gift to charity.
I have mixed feelings about it. I can see how it might create problems. But I don't have to think too hard to imagine the frustration a cancer patient might feel because a donor match couldn't be found. (In fact, I know some folks in the support group who have been in that situation.) So I guess I'm thinking that anything that helps a cancer patient can't be bad.
***************************
On a related note: I heard about this change in the law again on a radio show this afternoon. The person explaining it all did a really good job, until the host asked her to explain how this could save people's lives. She said, "Oh, it can help lots of people. Leukemia victims--"
Grrrr.
I hate cancer patients being referred to as "victims." There's a helplessness that goes along with that word, and I don't like other people assuming that someone with cancer is helpless. Because sometimes it makes the patient feel helpless. And helplessness and victimization are about the loss of hope. And making people lose hope pisses me off.
And she was doing so well in the interview up to that point....
Sunday, December 4, 2011
Viagra and Cancer
Viagra and Cancer in the news: Scientists in Germany recently created mice that had melanoma. They gave Viagra to some of the mice. The mice that had Viagra lived twice as long as those that didn't take it.
This builds on previous research that seemed to indicate that Viagra helped the immune system of cancer patients.
Viagra for cancer patients. There are so many jokes to be made, I don't even know where to begin.
This builds on previous research that seemed to indicate that Viagra helped the immune system of cancer patients.
Viagra for cancer patients. There are so many jokes to be made, I don't even know where to begin.
Thursday, December 1, 2011
ASH: Young Folks Like Me
Another update from ASH. It's one that I've been waiting for for almost 4 years.
The title is, "The Importance of Age in Prognosis of Follicular Lymphoma: Clinical Features and Life Expectancy of Patients Younger Than 40 Years." It's the first thing I've ever seen that looks specifically at younger Follicular NHL patients, and separates them out from statistics for the overall fNHL population. I think what they have to say is extremely encouraging.
*********
In general, I am not a fan of statistics about cancer, especially my cancer. The times I have been most depressed as a cancer patient have come because I have looked at cancer statistics that have given me bad news. That's wrong -- I'm not a statistic, and no other cancer patient is either. But when you live with so much uncertainty, you can't help but turn to the certainty that seems to come from statistics. It's just a bad place to go, though.
In the months after I was diagnosed, everything I read about fNHL said that the median Overall Survival was 8-10 years. For someone diagnosed at 40, this is not good to read. It dragged me down for months after I was diagnosed, until someone in the support group broke it down for me:
First, the 8-10 year statistic is outdated. It's more like 15 years; the 10 year statistic is from a study that took place before Rituxan existed. Second, Overall Survival (OS) measured deaths by any cause, not from cancer. So car accidents and heart attacks fit in there, too. Third, "median survival" means half of the people lived less than 10 years, but half lived more than 10 years: anywhere from 10 years to 40, 50, 60 years, and maybe beyond. Finally and most importantly, fNHL is typically diagnosed in people in their 60's. So a 15 year survival rate for a 65 year old man isn't that far off from the life expectancy for a non-cancer patient at 65 (which is about 17 years).
All of that put my mind at ease.
Still, I wanted some information about younger patients. I can accept that most fNHL patients are over 60. But I had no sense of how fNHL affected young folks like me.
*************
And now I do. This study looked at just over 1000 European fNHL patients, tracking them over 25 years. About 15% of them (153) were 40 or younger. (They broke the rest into two categories: ages 41-59, and 60 over.)
They found some pretty interesting differences between younger and older patients. Compared to older patients, younger patients are more likely to have bone marrow involvement (not an issue for me), more likely to have more than 4 node regions affected (much like me), less likely to watch and wait (unlike me), and less likley to receive Rituxan (not like me).
Buit it's survival statistics that were what really caught my eye.
The overall survival for patients over 60 was 6 years.
For those between 41 and 59, it was 16 years.
Anf for those 40 and younger, a whopping 24 years.
Now think about that: someone diagnosed at 40 sees the statistics on Wikipedia and thinks, I have 8 to 10 years. Now? 24 years -- I'll be an old man if that holds up.
That's huge. Not because the statistics mean anything for an individual. No one knows how long they'll have. But psychologically, how much easier is to fight that battle, knowing that the odds of growing old are that much better?
Major, major implications.
One more thing: the study found that, regardless of age, the incidence for transformation to a more aggressive type of lymphoma (every fNHLer's worst nightmare) was just 18%. I've seen it put at anywhere from 30% to 50% of patients transforming at some point. This would seem to put it at the lower end.
So, yeah, I know, I'm looking at statistics only when they give me good news, and I ignore them when they give bad news. And a study of 153 patients 40 and under is a pretty tiny number, especially when an even smaller number was probably right at 40, like me. But that's OK. In the war against the emotions, which for a Follicular patient is just as big a war as the physical one, this is an atom bomb.
Dropped in our favor.
The title is, "The Importance of Age in Prognosis of Follicular Lymphoma: Clinical Features and Life Expectancy of Patients Younger Than 40 Years." It's the first thing I've ever seen that looks specifically at younger Follicular NHL patients, and separates them out from statistics for the overall fNHL population. I think what they have to say is extremely encouraging.
*********
In general, I am not a fan of statistics about cancer, especially my cancer. The times I have been most depressed as a cancer patient have come because I have looked at cancer statistics that have given me bad news. That's wrong -- I'm not a statistic, and no other cancer patient is either. But when you live with so much uncertainty, you can't help but turn to the certainty that seems to come from statistics. It's just a bad place to go, though.
In the months after I was diagnosed, everything I read about fNHL said that the median Overall Survival was 8-10 years. For someone diagnosed at 40, this is not good to read. It dragged me down for months after I was diagnosed, until someone in the support group broke it down for me:
First, the 8-10 year statistic is outdated. It's more like 15 years; the 10 year statistic is from a study that took place before Rituxan existed. Second, Overall Survival (OS) measured deaths by any cause, not from cancer. So car accidents and heart attacks fit in there, too. Third, "median survival" means half of the people lived less than 10 years, but half lived more than 10 years: anywhere from 10 years to 40, 50, 60 years, and maybe beyond. Finally and most importantly, fNHL is typically diagnosed in people in their 60's. So a 15 year survival rate for a 65 year old man isn't that far off from the life expectancy for a non-cancer patient at 65 (which is about 17 years).
All of that put my mind at ease.
Still, I wanted some information about younger patients. I can accept that most fNHL patients are over 60. But I had no sense of how fNHL affected young folks like me.
*************
And now I do. This study looked at just over 1000 European fNHL patients, tracking them over 25 years. About 15% of them (153) were 40 or younger. (They broke the rest into two categories: ages 41-59, and 60 over.)
They found some pretty interesting differences between younger and older patients. Compared to older patients, younger patients are more likely to have bone marrow involvement (not an issue for me), more likely to have more than 4 node regions affected (much like me), less likely to watch and wait (unlike me), and less likley to receive Rituxan (not like me).
Buit it's survival statistics that were what really caught my eye.
The overall survival for patients over 60 was 6 years.
For those between 41 and 59, it was 16 years.
Anf for those 40 and younger, a whopping 24 years.
Now think about that: someone diagnosed at 40 sees the statistics on Wikipedia and thinks, I have 8 to 10 years. Now? 24 years -- I'll be an old man if that holds up.
That's huge. Not because the statistics mean anything for an individual. No one knows how long they'll have. But psychologically, how much easier is to fight that battle, knowing that the odds of growing old are that much better?
Major, major implications.
One more thing: the study found that, regardless of age, the incidence for transformation to a more aggressive type of lymphoma (every fNHLer's worst nightmare) was just 18%. I've seen it put at anywhere from 30% to 50% of patients transforming at some point. This would seem to put it at the lower end.
So, yeah, I know, I'm looking at statistics only when they give me good news, and I ignore them when they give bad news. And a study of 153 patients 40 and under is a pretty tiny number, especially when an even smaller number was probably right at 40, like me. But that's OK. In the war against the emotions, which for a Follicular patient is just as big a war as the physical one, this is an atom bomb.
Dropped in our favor.
Tuesday, November 29, 2011
Pay Me
Today is "Pay a Blogger Day," as declared by the web site Flattr.
Here's their description:
"Blogs are something that we read almost daily but how often do we step back and think about the time and effort that goes into writing an enjoyable, informative and entertaining post? Day after day, week after week, and keep the enthusiasm that writing brings the author? Pay a Blogger Day is our effort to put the bloggers in the spotlight to recognize the value they bring to the internet."
So, basically, I've been providing all kinds of great information and entertainment to you all for almost 4 years now, and it's time to give me something back. Flattr suggests giving me about $10 by clicking my "donate" button, or buying my merchandise.
Of course, I have no "donate" button, nor any merchandise (although I've considered selling "Nodes of Gold" t-shirts). I don't even have any advertising that you can click on to make Google send me some cash.
Which is fine. This blog is at least as much for me as it is for you. Besides, Flattr made up the whole Special Day because they're a micropayment service and they want me to set them up as my donation administrator, so really it's just a way for them to drum up business. Which is also fine. I don't begrudge anyone the chance to make money. (But I don't plan on helping them, either.)
You still feel the need to pay me? Buy me a beer some time if you see me. Or make a donation to a cancer organization. The Pan Mass Challenge, maybe? Or LLS? Or maybe Patients Against Lymphoma? I've benefited, directly or indirectly, from all of them.
And if you still want to pay me, but you have no money to spare, then leave me a comment. Writers love to know they are being read. Tell me you like the blog. That's worth plenty to me.
Thanks for your support -- monetary or otherwise.
Here's their description:
"Blogs are something that we read almost daily but how often do we step back and think about the time and effort that goes into writing an enjoyable, informative and entertaining post? Day after day, week after week, and keep the enthusiasm that writing brings the author? Pay a Blogger Day is our effort to put the bloggers in the spotlight to recognize the value they bring to the internet."
So, basically, I've been providing all kinds of great information and entertainment to you all for almost 4 years now, and it's time to give me something back. Flattr suggests giving me about $10 by clicking my "donate" button, or buying my merchandise.
Of course, I have no "donate" button, nor any merchandise (although I've considered selling "Nodes of Gold" t-shirts). I don't even have any advertising that you can click on to make Google send me some cash.
Which is fine. This blog is at least as much for me as it is for you. Besides, Flattr made up the whole Special Day because they're a micropayment service and they want me to set them up as my donation administrator, so really it's just a way for them to drum up business. Which is also fine. I don't begrudge anyone the chance to make money. (But I don't plan on helping them, either.)
You still feel the need to pay me? Buy me a beer some time if you see me. Or make a donation to a cancer organization. The Pan Mass Challenge, maybe? Or LLS? Or maybe Patients Against Lymphoma? I've benefited, directly or indirectly, from all of them.
And if you still want to pay me, but you have no money to spare, then leave me a comment. Writers love to know they are being read. Tell me you like the blog. That's worth plenty to me.
Thanks for your support -- monetary or otherwise.
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