The Motley Fool investing website has another lymphoma-related article up. This one talks about investment opportunities in companies that create and market monoclonal antibodies.
Of course, the lymphoma connection comes in the discussion about Roche, owner of My Old Pal Rituxan. Apparently, Rituxan generates about $7 billion in sales every year, more than Roche's other big MABs, Avastin, which discourages blood vessel growth in solid cancers, and Herceptin, which has made such a difference for so many breast cancer patients.
A couple of thoughts on this:
First, I found it kind of amazing that Rituxan sales were so high. But I guess it makes sense. Rituxan is used in a bunch of B cell Lymophomas, not just Follicular Lymphoma, but also some leukemias, as well as autoimmune diseases like Rheumatoid Arthritis, MS, and Lupus. Pretty impressive little MAB there.
That also gets me thinking about difficult it has been to find another MAB that trumps Rituxan. There really isn't anything approved yet that shows huge gains over Rituxan in terms of effectiveness. At some point, I have to wonder if we've plateaued on MABs for Follicular Lymphoma, and maybe we need to turn our attention elsewhere. (When I say "our," of course, I mean "researchers." We're all in this together.)
That said, there are still a ton of MABs for Follicular Lymphoma (and other blood cancers) in various stages of development, and it will take years before they are fully developed and explored in combination with other treatments, so I don't want to jump the gun.
Finally, I still have mixed feelings about people profiting off of my cancer, but I know I need to get over that. Treatments take many years and millions of dollars to develop, so there needs to be some incentive for people to pony up the money to make that happen. A friend of mine, a liver cancer survivor, told me he made a bundle on a treatment that was in trial. He was rejected for the trial, which upset him, because he was sure the treatment was going to take off. So he invested in the company anyway, and early trial results gave him a nice profit -- and some satisfaction.
So I hope other MABs, and other Follicular Lymphoma treatments, make someone a ton of money. That can only mean they're working.
Friday, August 30, 2013
Wednesday, August 28, 2013
Cancer Awareness for Men
The Lehigh Valley Iron Pigs, a minor league baseball team from Pennsylvania, hosted a Prostate Cancer Awareness Night last night. Players and coaches wore special uniforms, and there was a raffle to benefit The Prostate Cancer Awareness Fund of the Lehigh Valley.
But the highlight had to be the "foam finger" giveaway. The first 3500 fans 18 and older received one, courtesy of the Urology Specialists of the Lehigh Valley.
I'm going to just withhold any other comment, other than to say I'm all for anything that encourages people to get any kind of cancer screening (and yes, Urology Specialists will be offering a free health assessment, including a PSA test and digital exam), and I generally love any attempts at cancer humor.
But the highlight had to be the "foam finger" giveaway. The first 3500 fans 18 and older received one, courtesy of the Urology Specialists of the Lehigh Valley.
I'm going to just withhold any other comment, other than to say I'm all for anything that encourages people to get any kind of cancer screening (and yes, Urology Specialists will be offering a free health assessment, including a PSA test and digital exam), and I generally love any attempts at cancer humor.
Monday, August 26, 2013
Rituxan Maintenance for Follicular Lymphoma
The soon-to-be-published next issue of the Journal of Clinical Oncology has another significant article coming out, this one reporting the results of a phase III trial looking at Rituxan maintenance in a specific population. It raises some interesting questions about the effectiveness of R maintenance -- more on that in a little bit.
The study focused on Follicular Lymphoma patients over 60 who had not received treatment. The researchers had two overarching goals -- the same goals that most researchers of FL treatments have: First, how can we find an effective treatment with less toxicity? Second, can we make the good results last longer than other treatments?
Their solution was to try a shorter course of R-FND (Rituxan, Fludarabine, Mitoxantrone, and Dexamethason), a not-uncommon treatment for older patients. (Fludarabine is fairly effective, but might get in the way of collecting stem cells later on, and can cause some secondary blood cancers years down the road -- less of a risk for older patients.) The patients received four monthly R-FND treatments, a less intense course than is typically given. These were followed up by a consolidation therapy (a second, different treatment given immediately after the first one, meant to catch any cancery leftovers): four weekly rounds of Rituxan.
This part of the study was fairly successful. Overall response was 86%, with 69% having a complete response. This answers that first question (how can we find an effective treatment with less toxicity?) with a big Yes.
Then came the second part of the study. The patients who remained in the study were divided into two groups: half were given Rituxan Maintenance (4 rounds, given every two months) and the other half were observed with no additional treatment. So, the answer to the second question (can we make the good results last longer than other treatments?) was a no. While the R-maintenance group had a 2-year Progression Free Survival of 81%, and the observation group's was 69%, this was not considered statistically significant (that is, there wasn't a big enough difference to say for sure that it was the Rituxan and not some other random factor).
On the surface, this would seem to be a blow for Rituxan maintenance. There was, after all, no real difference between the two groups.
However, two wicked smaht people from Dana-Farber in Boston wrote an accompanying editorial on the study called "One Size Does Not Fit All in Follicular Lymphoma." In their analysis of the study, R-maintenance isn't necessarily ineffective for FL. They point out that this is one of the few that does not show a benefit for R-maintenance. Another study, for example, tried R-maintenance with three groups -- some receiving R-CHOP, some R-CVP, and some R+another Fludarabine combo. The one that didn't get a maintenance benefit? The Fludarabine group. Their conclusion? Maybe R-maintenance doesn't work with some initial treatments (*cough-Fludarabine-cough*). They also point out that, given how effective Bendamustine is, with its much lower toxicity, maybe we just shouldn't bother with Fludarabine? Their final word: let's not assume Rituxan maintenance with work on everyone with Follicular Lymphoma; let's figure out which treatments it works best with first, and then use it with them.
I don't have much to add; the good folks from Boston did a fine job with their analysis. (Because, you know, they are cancer researchers at Dana-Farber, as opposed to me, who isn't.)
But it does provide some excellent food for thought when treatment decisions have to be made.
The study focused on Follicular Lymphoma patients over 60 who had not received treatment. The researchers had two overarching goals -- the same goals that most researchers of FL treatments have: First, how can we find an effective treatment with less toxicity? Second, can we make the good results last longer than other treatments?
Their solution was to try a shorter course of R-FND (Rituxan, Fludarabine, Mitoxantrone, and Dexamethason), a not-uncommon treatment for older patients. (Fludarabine is fairly effective, but might get in the way of collecting stem cells later on, and can cause some secondary blood cancers years down the road -- less of a risk for older patients.) The patients received four monthly R-FND treatments, a less intense course than is typically given. These were followed up by a consolidation therapy (a second, different treatment given immediately after the first one, meant to catch any cancery leftovers): four weekly rounds of Rituxan.
This part of the study was fairly successful. Overall response was 86%, with 69% having a complete response. This answers that first question (how can we find an effective treatment with less toxicity?) with a big Yes.
Then came the second part of the study. The patients who remained in the study were divided into two groups: half were given Rituxan Maintenance (4 rounds, given every two months) and the other half were observed with no additional treatment. So, the answer to the second question (can we make the good results last longer than other treatments?) was a no. While the R-maintenance group had a 2-year Progression Free Survival of 81%, and the observation group's was 69%, this was not considered statistically significant (that is, there wasn't a big enough difference to say for sure that it was the Rituxan and not some other random factor).
On the surface, this would seem to be a blow for Rituxan maintenance. There was, after all, no real difference between the two groups.
However, two wicked smaht people from Dana-Farber in Boston wrote an accompanying editorial on the study called "One Size Does Not Fit All in Follicular Lymphoma." In their analysis of the study, R-maintenance isn't necessarily ineffective for FL. They point out that this is one of the few that does not show a benefit for R-maintenance. Another study, for example, tried R-maintenance with three groups -- some receiving R-CHOP, some R-CVP, and some R+another Fludarabine combo. The one that didn't get a maintenance benefit? The Fludarabine group. Their conclusion? Maybe R-maintenance doesn't work with some initial treatments (*cough-Fludarabine-cough*). They also point out that, given how effective Bendamustine is, with its much lower toxicity, maybe we just shouldn't bother with Fludarabine? Their final word: let's not assume Rituxan maintenance with work on everyone with Follicular Lymphoma; let's figure out which treatments it works best with first, and then use it with them.
I don't have much to add; the good folks from Boston did a fine job with their analysis. (Because, you know, they are cancer researchers at Dana-Farber, as opposed to me, who isn't.)
But it does provide some excellent food for thought when treatment decisions have to be made.
Friday, August 23, 2013
Follicular Lymphoma: Obinutuzumab (GA101)
From the August 10 edition of The Journal of Clinical Oncology comes a report from France on dosing for Obinutuzumab (also known as GA101).
Not a hugely ground-breaking report (though it is part of a larger study): 40 Follicular Lymphoma patients were given Obinutuzumab, but in different doses. Half the patients received 400 mg of Obinutuzumab for 8 cycles; the other half received 1600 mg initially, and then 800 for the rest of the cycles. Results were clearly better for the 1600 group: 55% had a response, while only 17% of the 400 group responded.
That 55% doesn't seem all that impressive, but there are further results that make this a little better: 38 of the 40 patients had already had Rituxan, and 22 of them were refractory to Rituxan (meaning Rituxan had pretty much stopped working, which is not uncommon with Rituxan). Of the 10 patients who were refractory and had the 1600 mg, 5 had a response. Of the 12 in the 400 group, only 1 had a response.
I think this is significant. Obinutuzumab might be an option for people who tried Rituxan and had it fail. Both target CD20 on B cells, but apparently work by different mechanisms (so says the head of the study, Dr. Gilles Salles, in another article that reported on these results).
Now, as I was writng this, I couldn't help thinking about another very recent report on a Monoclonal Antibody seen as a rival to Rituxan -- Epratuzumab, which had very similar results to Rituxan, and which I was kind of negative about in a post last week. The two reports (on Epratuzumab and Obinutuzuma) are similar in a way, both offering alternatives to Rituxan, with presumably similar side effects. So why am I a little more excited about this report on Obinutuzumab, which doesn't seem as effective as Rituxan?
Let me clear: I'm not down on Epratuzumab by any means. I think it's a great thing, and another necessary arrow in the quiver. But I really objected to the way the manufacturer was "selling" it in the press release, as something people can try if they don't want chemo. I guess I don't like it's being presented as a choice, as if fear of losing hair is the only factor. It certainly is a factor -- I would never discount the emotional issues that go into choosing a treatment. If that's the only issue, there are other things to try -- including Rituxan. Why offer a choice when time could be spent on something better than what we have?
Obinutuzumab, as it is presented here, is not just a choice other than Rituxan. It's an option for when Rituxan fails. There is, to me, a big difference.
It's hard being a cancer patient. There are people who think having an indolent lymphoma is good ("If you're going to have one, this is the one to have," some of us have heard). We have more choices, and often more time to choose. We're lucky that way. But it has its downsides, too.
The bottom line is, as Follicular Lymphoma patients, we have three possible monoclonal antibodies to choose from -- Rituxan, Epratuzuma, and Obinutuzumab. They do different things, and they'll be appropriate in different situations. With our oncologists' help, we should be able to make the right choice.
Not a hugely ground-breaking report (though it is part of a larger study): 40 Follicular Lymphoma patients were given Obinutuzumab, but in different doses. Half the patients received 400 mg of Obinutuzumab for 8 cycles; the other half received 1600 mg initially, and then 800 for the rest of the cycles. Results were clearly better for the 1600 group: 55% had a response, while only 17% of the 400 group responded.
That 55% doesn't seem all that impressive, but there are further results that make this a little better: 38 of the 40 patients had already had Rituxan, and 22 of them were refractory to Rituxan (meaning Rituxan had pretty much stopped working, which is not uncommon with Rituxan). Of the 10 patients who were refractory and had the 1600 mg, 5 had a response. Of the 12 in the 400 group, only 1 had a response.
I think this is significant. Obinutuzumab might be an option for people who tried Rituxan and had it fail. Both target CD20 on B cells, but apparently work by different mechanisms (so says the head of the study, Dr. Gilles Salles, in another article that reported on these results).
Now, as I was writng this, I couldn't help thinking about another very recent report on a Monoclonal Antibody seen as a rival to Rituxan -- Epratuzumab, which had very similar results to Rituxan, and which I was kind of negative about in a post last week. The two reports (on Epratuzumab and Obinutuzuma) are similar in a way, both offering alternatives to Rituxan, with presumably similar side effects. So why am I a little more excited about this report on Obinutuzumab, which doesn't seem as effective as Rituxan?
Let me clear: I'm not down on Epratuzumab by any means. I think it's a great thing, and another necessary arrow in the quiver. But I really objected to the way the manufacturer was "selling" it in the press release, as something people can try if they don't want chemo. I guess I don't like it's being presented as a choice, as if fear of losing hair is the only factor. It certainly is a factor -- I would never discount the emotional issues that go into choosing a treatment. If that's the only issue, there are other things to try -- including Rituxan. Why offer a choice when time could be spent on something better than what we have?
Obinutuzumab, as it is presented here, is not just a choice other than Rituxan. It's an option for when Rituxan fails. There is, to me, a big difference.
It's hard being a cancer patient. There are people who think having an indolent lymphoma is good ("If you're going to have one, this is the one to have," some of us have heard). We have more choices, and often more time to choose. We're lucky that way. But it has its downsides, too.
The bottom line is, as Follicular Lymphoma patients, we have three possible monoclonal antibodies to choose from -- Rituxan, Epratuzuma, and Obinutuzumab. They do different things, and they'll be appropriate in different situations. With our oncologists' help, we should be able to make the right choice.
Wednesday, August 21, 2013
Stress (from Cancer and Other Things)
I saw this on a lymphoma group on Facebook this morning, though it's made the rounds for a few months (and it's usually cited as "source unknown," so I can't give proper credit):
****************************
A psychologist walked around a room while teaching stress management to an audience. As she raised a glass of water, everyone expected they'd be asked the "half empty or half full" question. Instead, with a smile on her face, she inquired: "How heavy is this glass of water?"
Answers called out ranged from 8 oz. to 20 oz.
She replied, "The absolute weight doesn't matter. It depends on how long I hold it.
"If I hold it for a minute, it's not a problem. If I hold it for an hour, I'll have an ache in my arm. If I hold it for a day, my arm will feel numb and paralyzed. In each case, the weight of the glass doesn't change, but the longer I hold it, the heavier it becomes."
She continued, "The stresses and worries in life are like that glass of water. Think about them for a while and nothing happens. Think about them a bit longer and they begin to hurt. And if you think about them all day long, you will feel paralyzed – incapable of doing anything."
It’s important to remember to let go of your stresses. As early in the evening as you can, put all your burdens down. Don't carry them through the evening and into the night. Remember to put the glass down!
************************
I know that's easier said than done for lots of people -- maybe most people. But sometimes I think it's easy to worry about what might happen, rather than what it happening. There's a difference between preparing for what comes next and focusing on the worst possible outcome.
I've written many times before that, with a wife, three double-digit-aged kids, a full-time job, and an insane dog, I am a very busy man. And I consider myself very lucky to be so busy. I have all of those people and things to care about, and to care about me, and the good health to stay busy enjoying them.
I wish all of you the good health and busy-ness to not have time to stand around holding a glass of water.
(That story is aimed to two people in particular -- you probably know who you are....)
****************************
A psychologist walked around a room while teaching stress management to an audience. As she raised a glass of water, everyone expected they'd be asked the "half empty or half full" question. Instead, with a smile on her face, she inquired: "How heavy is this glass of water?"
Answers called out ranged from 8 oz. to 20 oz.
She replied, "The absolute weight doesn't matter. It depends on how long I hold it.
"If I hold it for a minute, it's not a problem. If I hold it for an hour, I'll have an ache in my arm. If I hold it for a day, my arm will feel numb and paralyzed. In each case, the weight of the glass doesn't change, but the longer I hold it, the heavier it becomes."
She continued, "The stresses and worries in life are like that glass of water. Think about them for a while and nothing happens. Think about them a bit longer and they begin to hurt. And if you think about them all day long, you will feel paralyzed – incapable of doing anything."
It’s important to remember to let go of your stresses. As early in the evening as you can, put all your burdens down. Don't carry them through the evening and into the night. Remember to put the glass down!
************************
I know that's easier said than done for lots of people -- maybe most people. But sometimes I think it's easy to worry about what might happen, rather than what it happening. There's a difference between preparing for what comes next and focusing on the worst possible outcome.
I've written many times before that, with a wife, three double-digit-aged kids, a full-time job, and an insane dog, I am a very busy man. And I consider myself very lucky to be so busy. I have all of those people and things to care about, and to care about me, and the good health to stay busy enjoying them.
I wish all of you the good health and busy-ness to not have time to stand around holding a glass of water.
(That story is aimed to two people in particular -- you probably know who you are....)
Sunday, August 18, 2013
Ibrutinib and R-CHOP
This is a little bit related to Follicular Lymphoma, but enough that it's probably worth mentioning.
An early-phase study of Ibrutinib combined with Rituxan and the CHOP chemotherapy had good results for patients with DLBCL. Only 15 patients in the study, but all of them had responses -- 10 complete and 5 partial. The study's primary aims were to determine optimal dosage for Ibrutinib and to determine side effects. The results were good enough to warrent larger trials with more patients.
I think this is important for Follicular Lymphoma patients for several reasons:
First, the results for those 15 patients came after an initial trial involving patients with otiher types of NHL, including Follicular Lymphoma. All of those patients had a response, which led to the second part, with just the DLBCL patients. So there is some (very small) indication that this combination could work well someday for Follicular patients.
This is not a surprise, of course. R-CHOP has long been a choice for FL patients, and Ibrutinib seems to be working for us, too. The question was whether or not they would interfere with each other. It seems like they don't.
That's the second (related) reason. There's a school of thought that traditional chemo isn't going away any time soon, and rather than looking for alternatives, we should be looking to enhance what we have, that we know is effective. This lends some support to that way of thinking. It's the same thinking that encourages RIT as a consolidation therapy -- getting Zevalin right after R-CHOP. You have three different ways of attacking the cancer cells: chemo + antibody + RIT. This approach does something similar: chemo + antibody + kinase inhibitor. There's something to be said for this way of thinking. Until we have one treatment that can handle the job, ganging up might be the way to go.
Finally, as much as we hate to think about it, I'm always interested in treatments that might be an improvement in how we deal with DLBCL, since this is the lymphoma that most Follicular Lymphomas transform into, if and when it does transform. It might not be the exact same disease -- transformed DLBCL might be a little different than "original" DLBCL, which is why they have separate trials for them -- but it's good to know there's another avenue for future exploration by researchers.
As always, the warning: 15 patients is a really small number, and this is a really early trial. But it's got some stuff in there that make it worth keeping an eye on.
An early-phase study of Ibrutinib combined with Rituxan and the CHOP chemotherapy had good results for patients with DLBCL. Only 15 patients in the study, but all of them had responses -- 10 complete and 5 partial. The study's primary aims were to determine optimal dosage for Ibrutinib and to determine side effects. The results were good enough to warrent larger trials with more patients.
I think this is important for Follicular Lymphoma patients for several reasons:
First, the results for those 15 patients came after an initial trial involving patients with otiher types of NHL, including Follicular Lymphoma. All of those patients had a response, which led to the second part, with just the DLBCL patients. So there is some (very small) indication that this combination could work well someday for Follicular patients.
This is not a surprise, of course. R-CHOP has long been a choice for FL patients, and Ibrutinib seems to be working for us, too. The question was whether or not they would interfere with each other. It seems like they don't.
That's the second (related) reason. There's a school of thought that traditional chemo isn't going away any time soon, and rather than looking for alternatives, we should be looking to enhance what we have, that we know is effective. This lends some support to that way of thinking. It's the same thinking that encourages RIT as a consolidation therapy -- getting Zevalin right after R-CHOP. You have three different ways of attacking the cancer cells: chemo + antibody + RIT. This approach does something similar: chemo + antibody + kinase inhibitor. There's something to be said for this way of thinking. Until we have one treatment that can handle the job, ganging up might be the way to go.
Finally, as much as we hate to think about it, I'm always interested in treatments that might be an improvement in how we deal with DLBCL, since this is the lymphoma that most Follicular Lymphomas transform into, if and when it does transform. It might not be the exact same disease -- transformed DLBCL might be a little different than "original" DLBCL, which is why they have separate trials for them -- but it's good to know there's another avenue for future exploration by researchers.
As always, the warning: 15 patients is a really small number, and this is a really early trial. But it's got some stuff in there that make it worth keeping an eye on.
Thursday, August 15, 2013
Follicular Lymphoma: Epratuzumab
This just in:
Press release yesterday afternoon from Immunomedics with the results of a phase II trial of Epratuzumab and Rituxin in previously untreated Follicular Lymphoma patients.
Dang good results: 59 patients, 88.2% achieved a response. The breakdown: 25 of them (42.4%) had a complete response, and 27 (45.8%) had a partial response. Another 6 (10.2%) kept things stable. After 3 years, 60% of patients are still in remission.
Not bad at all.
Epratuzumab, like Rituxan, is a monoclonal antibody (there's that -mab ending again). While Rituxan targets the CD20 protein on a cancer cell, Epratuzumab goes after the CD22 protein. This seems to be why they work well together: if one misses a cell's target, the other might be able to catch it. Another difference is that Epratuzumab is humanized, unlike Rituxan, which is made from mouse cells. So Epratuzumab is likely to result in fewer allergic reactions.
Now, the cold water:
First, it's a phase II trial. I'm guessing the results will hold up in a larger, phase III trial, but it's still a while before FDA approval.
Second. the press release points out that "Although rituximab combined with chemotherapy has improved the survival of previously untreated patients with FL, many patients are unable or unwilling to tolerate chemotherapy," and thus this combination might be an alternative. Interesting way of positioning itself. If this is meant for initial therapy (the patients were all previously untreated), it's hard to tell if anyone would be "unable...to tolerate chemotherapy" before they actually had any chemo. I suppose the potential patient could have tried a round or two and then had a rough time and dropped it, and so this is an alternative. As for those "unwilling to tolerate chemotherapy," I can't imagine they wouldn't try straight Rituxan first (though it sounds like they received both MABs at the same time for four weeks; still, why not try just one?).
So, I guess I'm confused about who would use this, given that statement. The results are great, no question. But not all that much better than Rituxan, which has, if I remember correctly, about 75% overall response, and about 50% complete response, with about 24 months of progression free survival. Every little improvement helps, though I wonder how an insurance company will evaluate the additional cost for a few months of PFS.
That's uncharacteristically negative of me. Maybe I'm just hoping we can move beyond antibodies for initial treatments and focus more on some newer combinations? (Jeepers -- am I getting all spoiled by kinase inhibitors? Losing my boyish enthusiasm for every new treatment? I hope not....)
OK, we'll call it good news. Epratuzumab is definitely another arrow in the quiver. But I want to see more.
Press release yesterday afternoon from Immunomedics with the results of a phase II trial of Epratuzumab and Rituxin in previously untreated Follicular Lymphoma patients.
Dang good results: 59 patients, 88.2% achieved a response. The breakdown: 25 of them (42.4%) had a complete response, and 27 (45.8%) had a partial response. Another 6 (10.2%) kept things stable. After 3 years, 60% of patients are still in remission.
Not bad at all.
Epratuzumab, like Rituxan, is a monoclonal antibody (there's that -mab ending again). While Rituxan targets the CD20 protein on a cancer cell, Epratuzumab goes after the CD22 protein. This seems to be why they work well together: if one misses a cell's target, the other might be able to catch it. Another difference is that Epratuzumab is humanized, unlike Rituxan, which is made from mouse cells. So Epratuzumab is likely to result in fewer allergic reactions.
Now, the cold water:
First, it's a phase II trial. I'm guessing the results will hold up in a larger, phase III trial, but it's still a while before FDA approval.
Second. the press release points out that "Although rituximab combined with chemotherapy has improved the survival of previously untreated patients with FL, many patients are unable or unwilling to tolerate chemotherapy," and thus this combination might be an alternative. Interesting way of positioning itself. If this is meant for initial therapy (the patients were all previously untreated), it's hard to tell if anyone would be "unable...to tolerate chemotherapy" before they actually had any chemo. I suppose the potential patient could have tried a round or two and then had a rough time and dropped it, and so this is an alternative. As for those "unwilling to tolerate chemotherapy," I can't imagine they wouldn't try straight Rituxan first (though it sounds like they received both MABs at the same time for four weeks; still, why not try just one?).
So, I guess I'm confused about who would use this, given that statement. The results are great, no question. But not all that much better than Rituxan, which has, if I remember correctly, about 75% overall response, and about 50% complete response, with about 24 months of progression free survival. Every little improvement helps, though I wonder how an insurance company will evaluate the additional cost for a few months of PFS.
That's uncharacteristically negative of me. Maybe I'm just hoping we can move beyond antibodies for initial treatments and focus more on some newer combinations? (Jeepers -- am I getting all spoiled by kinase inhibitors? Losing my boyish enthusiasm for every new treatment? I hope not....)
OK, we'll call it good news. Epratuzumab is definitely another arrow in the quiver. But I want to see more.
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