Zevalin Update for Follicular Lymphoma

From a couple of weeks ago, and early publication from The Annals of Hematology reporting on the long-term success of some Follicular Lymphoma patients who had received Zevalin.

A quick explanation if you don't know what Zevalin is:

Zevalin is a type of RadioImmuno Therapy, or RIT. Traditional radiation had limited use on most types of blood cancers, since radiation can't usually hit a moving target, like a circulating blood cell. RIT takes something that tracks down blood cells (think Rituxan) and attaches a small dose of radiation to it, so it can be delivered directly to the affected blood cells.

Zevalin, and other RITs, have had some success, but for a whole bunch of reasons, are not used very often on Follicular Lymphoma patients. Read more on RIT at Lymphomation.org.

So this study looked at 37 Follicular Lymphoma patients who had received Zevalin. As I said, Zevalin works: 34 of the 37 had a Complete Response. Long term, it did its job for most of the patients, though it certainly wasn't a cure. Patients reported decent Quality of Life results, too. I'll let you look at the numbers yourselves.

I think, even with a small study like this which is "outside of a clinical trial," it's clear that Zevalin is effective long-term. I'm not sure this adds anything new to what we've known about Zevalin, and since it's outside of a clinical trial, there are lots of questions about how representative the patients are.

But it's nice to see at least some evidence that Zevalin is still a valid option for us.

I'm not sure this study will result in increased use, but it keeps it at the front of everyone's minds, anyway, which might be about the best we can hope for. Good to remember that arrow is in the quiver.

Stem Cell Transplants....For Dogs

As I mentioned a week or so ago, I've been away for a little while. Couldn't bring the dog. I miss her, even though she's useless to me as a cancer-sniffing dog. (Really, she's kind of useless as a dog in general. But she's sweet and she looks great, so we go with that. here's the little princess:

We assume she misses us, too.)

Anyway, I've been thinking about her, and it reminded me of an article from last month on dogs with lymphoma. I'd never wish lymphoma on any creature, two- or four-legged, but it's pretty cool to hear about how work on human lymphoma at the Fred Hutchinson Cancer Center in Seattle is being used to help dogs.

Also, there's some good news about cancer vaccines for dogs, too.


Obviously, dogs aren't people, but maybe the things we learn from dogs can be translated in some way to what we know about people cancer. Even indirectly.

I still miss my dog. We'll be home soon, baby.  And I know you're in great hands, and probably having a much better time than you would with us, anyway. You'd just be sitting at my feet while I read cancer journals, rather than playing with your friends.

Hope everyone is staying healthy.

Bendamustine: An Overview

The July issue of the Leukemia and Lymphoma journal features an article written by Dr. Enrico Derenzini, Dr. Pier Luigi Zinzani, and Lymphoma Rock star Dr. Bruce Cheson, called "Bendamustine: Role and Evidence in Lymphoma Therapy, An Overview."

The article is written for oncologists who want to know more about Bendamustine and how it might be used for a number of lymphomas and other blood cancers, including Follicular Lymphoma, of course.

The article gives some history on how Bendamustine was developed, how and why it works on lymphoma cells, how it might best be used, and what clinical trials have told us about its effectiveness.

In the article, you'll learn some fascinating tidbits, like:

• Bendamustine was developed in East Germany in the early 1960s, but wasn't widely used or known about in Western Europe and the U.S. until the early 1990s, after things opened up over there.
• It is related to the mustard has used in World War I.
• It is generally better tolerated and more effective than CHOP, especially when combined with Rituxan.
• It was named for Benedetto DaMustini, a young Italian immigrant who sold sausages from a small stand outside the East German hospital where it was developed. One night, after a long session of working on the compound, the lead researcher was about to give up on his efforts. He stopped for a sausage at the stand, and, refreshed by his snack, returned to work in the lab. A few hours later, he had his breakthrough. He went outside, thanked the boy for his sausage, asked the boy his name, and declared that he would name his new cancer treatment Bendamustine after young Benedetto DaMustini.

I actually made up that last fascinating tidbit. But I had so much fun thinking about writing a screenplay involving two monkeys named Johnny and Gonzalez who helped develop a Rituxan Biosimilar that I decided to work on a prequel that focuses on chemotherapy development.

Anyway, the stuff that you actually learn from the article is pretty interesting on its own, particularly given how much more common Bendamustine is becoming as a treatment for Follicular Lymphoma. As I have mentioned before, Dr. R and I have talked about it as a possible next treatment for me, when it becomes necessary to have one, so I have a special interest in learning more about it.

Battling and Beating Cancer

Charlene McMann and Scott Seaman are featured on the WGN Radio show hosted by Patti Vasquez, discussing their book Batting and Beating Cancer: The Cancer Survival Book.

I haven't read the book, so I can't speak to it directly, but their discussion of the book is interesting. I particularly like that they pay attention to issues for caregivers. We so often forget about the ones that take care of us, the patients, and what they go through. They deserve some recognition.

I've written about McMann and Seaman before. They are founders of the Chicago Blood Cancer Foundation, and have done lots to raise awareness of (and money for) blood cancer issues in Chicago and around the country. Scott is a lymphoma survivor himself.

Good stuff. Worth the 25 minutes to listen.

Rituxan Substitute?

More Rituxan in the news. (What is the deal with Rituxan these days? Two posts about Rituxan in a row? It's been around forever, but still manages to make news. It's becoming the Joan Rivers of cancer treatments, for crying out loud.)

Anyway, Rituxan is in the news because its patent expires in 2018, meaning other companies can make generic versions -- and sell them cheaper. (A big chunk of the cost of a drug comes from recovering all of the research and development that went into finding, creating, and testing the drug, which can take years. Generics don't have to do all of that work, so they don't have those costs to recover. So, we get cheaper drugs.)

The big issues with generics is that they need "biosimilarity." This is where things get complicated. Many generic drugs are made by recreating a chemical. (It's more complicated than that -- not many of us can make our own home version of ibuprofin or something like that -- but it's fairly straightforward.) Biosimilarity involves drugs or medical products that are produced by living organisms. This includes Rituxan, which is made from mice.

So creating a biosimilar of Rituxan is a lot harder. It's more than just mixing chemicals in a lab; it's trying to duplicate the entire process of creating something that is itself created from a living organism. And when you're dealing with stuff that is or used to be alive, you've got a whole bunch more factors to control that are potentially hard to control.

Of course, the original manufacturer of Rituxan isn't going to make this easy by offering any help.

An article in this month's Leukemia and Lymphoma describes a European attempt (successful) to create a biosimilar version of Rituxan. It's for a medical journal, so it's fairly thick reading, but I think a version aimed at a more popular audience would make for fascinating reading. There are deadlines to be met, with scientists frantically trying to copy things. There are "freshly purified human natural killer cells." And there are two monkeys. They don't have names, but when I write my screenplay based on this article, the monkeys will be called Johnny and Gonzalez. And nobody but my father will get that joke.

Anyway, it's pretty interesting reading, and maybe makes us appreciate how difficult it is to develop the original version of a treatment, let alone a generic version.

It will be interesting to see how the patent expiration plays out, and what we get as a result. Cheaper monoclonal antibodies? Maybe something just a tiny bit better? or a tiny bit worse?

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A quick note about the next couple of weeks:
I'm off on a vacation with the family, and unlike the vacations I usually take, this one will leave me with limited internet access. I plan to post to Lympho Bob every few days, because it's important to me to keep up with it. But the posts will definitely be shorter, and maybe have some longer stretches in between. My plan is to get back to my usual blogging habits when I get back near the end of the month.

Rituxan and Infections

Good news on a potential side effect of Rituxan: according to a small German study of patients in a single treatment center, Rituxan doesn't seem to increase the likelihood of a patient developing infections.

Rituxan works by targeting the protein CD20 on B cells, the type of white blood cell that (when being normal) works to keep out invaders, or (when being pains the rear) get all cancery and give you Follicular Lymphoma. Rituxan just goes for the CD20 -- it doesn't care if it's on a normal cell or a lymphoma cell.

The problem, of course, is that if Rituxan is wiping out normal cells, then those cells can't do their job of fighting off invaders. Thus, Rituxan can do a good job (warding off cancer) while doing a bad job (keeping the immune system from doing one of its jobs, and thus inviting infections).

This study looked at 125 patients with various types of lymphoma (80 of them had Follicular Lymphoma), who were given Rituxan as a first treatment -- either Rituxan by itself, or as part of a chemotherapy combination (lots of R-CHOP, some R-Bendamustine, and a few others, incluidng some funky German chemotherapies).

The article breaks down the number of patients with the different types of lymphomas, the numbers of patients who received which treatments, and the number and types of infections they developed. All very interesting.

The bottom line, though is this: there was no statistical significance to the number and type of infections. In other words, there is no evidence that receiving Rituxan increases the likelihood of developing an infection.

This is good news. While this has always been a concern, the authors note that very few actual studies have looked to see if the concern should really be a concern.

A couple of important things to consider, though: first, the study looked back at patients who received Rituxan between 2000 and 2005, before Rituxan Maintenance was used widely. It's possible that receiving Rituxan for a prolonged amount of time (after that initial 4 or 6 or 8 weeks) could have a stronger impact on the immune system. Makes sense -- while those first few doses last for a few months, a common course of R-Maintenance could see the effects go for more than 2 years. That might have a greater impact on the immune system, and encourage more infections.

The other important issue: it seems like infections are more likely for people who take Prednisone as part of their chemo (that's the P in CHOP). So that's something to keep an eye on, too.

Overall, though, it seems like good news. From my personal experience, I didn't really have any significant infection issues after my Rituxan. But I was a study of 1, not 125. Good to see it all played out in a broader, more serious study.

A New Vaccine for Follicular Lymphoma?

The blog for Mount Sinai Hospital put out a kind of teaser called "Novel Vaccine Fights Lymphoma" a few days ago. It's a little short on the kind of detail that would let me look into it all a little more, but it gives just enough to make me want to read more.

Researchers at the Tisch Cancer Institute at Mt. Sinai have developed a kind of internal vaccine. It works differently from the way something like BioVaxId works. With BioVax, a patient's immune cells are taken from the blood and trained to recognize cancer cells, then put back into nthe blood to go to work.

This one from Mt. Sinai is different. The focus here is on Dendritic Cells. Dendritic cells are important players in the immune system. In general, when someone's body is invaded by bacteria or a virus or something else that isn't supposed to be there, immune system cells go after it and kill it off. Dendritic cells are the middle men -- they first encounter the invader and then tell the immune cells what's going on, and let them know what kind of invader cell they should be looking for. They're like Bubbles from the The Wire, hanging around on the corner and then telling the police what he saw. (Sorry -- I just binge-watched all 5 seasons of The Wire on Amazon Prime.)

The point is, Dendritic Cells have to do their job of identifying an invader, and telling the immune system cells, before the immune system can attack an invader.

Now, the Mt. Sinai research is trying to take advantage of this natural system. Two "immune-modifying medicines" are injected into the tumor (presumably an effected lymph node; I'd really like to know what the medicines are exactly -- this is one of those places I'm getting sucked in by the tease). The patient is also given two days of low-dose radiation directly into the tumor. (This is standard radiation, not RIT.)

The first medicine sends the Dendritic Cells to the tumor, where they recognize the cells that have been affected by the radiation. The second medicine sends the Dendritic Cells out to the immune cells in the rest of the body, where they learn to recognize the cancer cells and track them down in the rest of the body.

What this is doing is giving the immune system a little push. Under normal circumstances, the immune system would recognize an invader, and all the various cells would do their jobs. But cancer isn't a normal circumstance, and the immune system is deceived by cancer cells. It needs a little help in recognizing and catching the bad guys. (Like Bubbles putting the red hats on the Barksdale crew. Gosh, I hope I'm not the only one out there who watches The Wire....)

This is very early research. Two patients in a trial experiences Partial Responses. But it's encouraging enough to warrant a larger trial of 30 patients.

The lead researcher, Dr. Joshua Brody, plans to present all of this at Lymphoma Conferences starting this summer. It will be interesting to see how the community reacts to it, and how it all gets refined as the research moves along.

Definitely worth keeping an eye on....