Another Cancer-Sniffing Dog

From a story last week:

Bella the cancer-sniffing dog. She detected her owner's breast cancer before the mammography did. She threw up while her owner was going through chemo. And she's the subject of a book. Very cool dog.

This is why I missed my dog so much when I was away (even though she never detected my cancer).

Promising RIT for Follicular Lymphoma?

There's a new cowboy in RITville.

(OK, that metaphor isn't my best. I'm on vacation.)

There's a new version of RIT that may be available at some point. Results from an early clinical trial look good.

RadioImmunoTherapy (RIT) is a fairly effective, but fairly underused type of treatment for NHL. Right now, there are two versions of RIT available, Bexxar and Zevalin. They are both effective, and have some differences between them that make the choice of one or the other better for some patients. (Lymphomation does an excellent job of comparing the two, which isn't surprising, because they do an excellent job at pretty much everything.) RIT works by providing radiation to lymphoma cells. Because blood cancer cells are moving targets, traditional radiation treatments don't work. So RIT treatments use something that can find and attach themselves to cancer cells (like Rituxan) and have that molecule carry a tiny dose of radiation, delivered directly to the cancer cell. Pretty cool system.


The current issue of the Journal of Nuclear Medicine reports on the results of a clinical trial for a version of RIT that uses luteum-177, added to Rituxan, as its delivery method. Lu 177 differs from the other RIT types because it doesn't penetrate tissue as deeply (and therefore won't travel too far beyond the targeted cancer cells, sparing more healthy cells).

The purpose of this trial was to determine the best dosage for this treatment, and it seems like they got decent results -- about 52% of patients got a response (29patients overall; 6 had a complete response and 9 had a partial response).

However, the results for the group of patients with Follicular Lymphoma were particularly good (it "appeared to have striking activity in follicular lymphoma," said the authors). of the 11 patients with FL, 9 had a response, for an 82% response rate. Excellent.

It's an early study, so it will need to go through more steps, and recruit more patients for tests. And then, there's the whole issue of whether or not it will be practical -- that is, whether or not it will run into the same problems as Zevalin and Bexxar, with their reimbursement and logistical problems. But maybe this will be the one that gets some attention and forces a re-evaluation of the uses of RIT.

Intestinal Bacteria and Lymphoma

I'm a little hesitant to link to this article, but I'm going to anyway, because I think it's pretty fascinating.

Researchers from UCLA's cancer center have found a potential link between lymphoma and certain types of gut bacteria. The presence of these bacteria seems to play a role in encouraging lymphoma growth.

I can't access the full online article, but that link is to a press release from UCLA.

I'd like to see the full article because I have some hesitancy about this one. If it plays out, it could be pretty great -- treatments could be developed that kill off bad bacteria and encourage good bacteria in the gut.

But I can also see this going in a less-good direction -- claims that Greek yogurt will cure cancer.

My biggest reason to be hesitant, though, is that the study involved mice, not people. Lots of strange things happen when bacteria are moved from one organism to another.

I'm especially interested in this because of my own gut issues, and I'd like to see if there's some connection between them. But that's going to take some serious research.

We'll file this one under "keep and eye on it."

Jon Lester

CNN.com ran a nice piece a couple of days ago written by Jon Lester, Boston Red Sox pitcher and lymphoma survivor. The piece highlights Lester's charity, NVRQT, which stands for "Never Quit"; the group focuses on pediatric cancer -- supporting research AND supporting kids with cancer.

I am, of course, a Boston native, and a life-long Red Sox fan, so Lester has played a pretty big role in my cancer life.

Lester was diagnosed with Anaplastic Large Cell Lymphoma in 2006. It's an aggressive NHL, and he went through some heavy duty chemo, returning to the Sox in 2007, and pitching in the decisive game 4 of their World Series victory that year.

I was diagnosed a few months later. When we broke the news to the kids, I had my arms around my boys. My oldest was the one who best understood was was going on with me, and I told him he'd heard of NHL before, reminding him about Jon Lester.  When he heard Lester's name, his whole body relaxed in my arms. He knew things were going to be OK. Of course, Lester had a very different type of Lymphoma that I have, but that didn't matter. What mattered was that he became a kind of symbol for us of someone who overcame this.

About 4 months after I was diagnosed, Lester threw a no-hitter. I turned on the game in the 8th inning and saw that Lester was three outs away from the no-no. I got my son out of bed, and we watched Lester finish it up. Needless to say, it was a pretty big day in our house.

And, of course, I wore my Jon Lester shirt for every one of my Rituxan appointments.It's still my lucky shirt when I need one.

Lester's not having a great year on the mound, and there is once again talk of trading him in the next couple of weeks. If that happens, I'll be pretty bummed. But it doesn't mean I won't get myself a new shirt.

Jimmy V

The ESPY Awards are being presented tonight. They're basically celebration of sports. I haven't watched them in years, though I did see a notice for them today, which made me at least look at who was up for awards this year.

There's a sad, sad lack of Boston pro athletes and teams on that list. But I do take a little comfort in several mentions of Louisville athletics. It's something, anyway.

But what it also made me think of was Jimmy V. This year is the 20th anniversary of Jim Valvano's moving speech at the ESPYs (back when it was shown in March).

If you've never seen it, or you haven't seen it in a while, it's worth a look.



Valvano is sick. His cancer was spreading fast, and he could barely get out of bed that day to receive the Arthur Ashe Courage Award. But the crowd gave him strength. His 3 minute speech went on for 10 minutes (he ignores the 30 second warning in classic fashion). He tells a very funny story, and he gives advice for living a full life: Every day, do three things -- laugh, think, and cry. It's advice that I still think about.

And he announced the formation of The V Foundation for Cancer Research, which has given away millions of dollars to cancer researchers to study a wide variety of cancer-related problems, including several dealing with lymphoma.

(By the way, this year's Arthur Ashe Courage Award winner is Robin Roberts -- an all-time great in basketball at her alma mater, Southeastern Louisiana University, and one of the first female anchors on ESPN's Sports Center, and, of course, cancer survivor.)

So good luck to whoever is up for an ESPY. May you use your fame for the good.

Follicular Lymphoma: GA101

The journal Blood has published the results of a phase 2 clinical trial involing GA101 (also known as Obinutuzumab) and chemotherapy. Results were very positive -- enough to consider Obinutuzumab as a possible alternative to Rituxan (?).

Obinutuzumab is similar to Rituxan, in that they are both monclonal antibodies that target the CD20 molecule on B cells. There have a been a whole bunch of monoclonal antibodies developed since Rituxan, though none really seems to do a better job. Obinutuzumab is different for two reasons: first it is fully humanized. That is, unlike Rituxan, which was developed from mouse cells, Obinutuzumab was developed from human cells. There is some speculation that this difference means fewer allergic reactions.

More importantly, Obinutuzumab is glycoengineered. Glycoengineering is a process whereby certain sugars on the antibody molecule are changed to the molecule attaches to its target more easily. Combine those two qualities -- better attachment and fewer side effects -- and you just might have an improvement on Rituxan.

The results from this clinical trial aren't going to determine whether we have a Rituxan replacement.

But it does point to the effectiveness of Obinutuzumabin combination with CHOP.

The trial involved combining Obinutuzumab with either CHOP or FC (Fludarabine and Cyclophosphamide), The important results are 1) there were no significant side effects (though there were more with FC than with CHOP), and 2) it's a pretty effective combination: 96% of patients receiving the CHOP combo had a response, and 93% of FC patients received a response.

Pretty darn good.

It's a phase 2 trial, so its goal is to prove that a phase 3 trial is worth conducting -- one with more participants, to show that the results can hold.

And this one trial won't really solve much, given all of that. I still contend, as I've said several times recently, that chemo is probably on its way out (though it won't disappear completely as an option -- it will diminish in use). So these results are great, but they're not the long-term solution we're looking for.

Stage 1 Follicular Lymphoma

I don't know how much this applies to most people who read Lympho Bob, but it's interesting nonetheless: some research from France on the impact of the choice of initial therapy on  Stage 1 Follicular Lymphoma patients.

Stage 1 Follicular Lymphoma describes patients who have been diagnosed with FL in one location -- a single cluster of lymph nodes, maybe under one arm. It's pretty rare to be diagnosed so early; the numbers I usually see say something like 10% of patients are diagnosed at stage 1. Most of us are at stage 3 or 4 -- involvement at multiple sites, above and below the diaphragm, maybe some organ involvement, too. Staging for Follicular Lymphoma isn't as important as it is for solid cancers. The same treatments are likely to work for stage 4 as for any other stage. Staging is about location more than intensity.

Except with stage 1. Traditionally, stage 1 Follicular Lymphoma is the one type that's thought to be curable. Because it is isolated to one area, it can often be treated with traditional radiation, and sometimes is cured.

This article looks at whether or not radiation is still the best option. No one has really revisited that since Rituxan became popular.

The researchers looked at 145 FL patients with stage 1 or 2 disease, and divided them into 6 groups, based on the treatment they received: 1) watching and waiting, 2) chemotherapy, 3) radiation, 4) radiation + chemo, 5) Rituxan, and 6) Rituxan + chemo.

The results were kind of mixed, in my opinion (and the abstract kind of fudges things a bit). While Rituxan had the lowest Complete Response rate (57%), and Radiation + Chemo had the highest CR (94.7%), both groups had the highest overall response rate -- 100%. But Radiation + chemo had a high relapse rate (84%), second only to straight radiation (90.5%). Rituxan's was 42.9%.

Their conclusion is that none of this seems to affect Overall Survival. Even the watching and waiting group had the same OS as everyone else -- pretty much in line with other studies, no matter what the stage.

Radiation might give people a shot at a cure, but if it doesn't work, it's not going to help them any more in the long run than if they'd just watched and waited.

These kinds of retrospective studies -- looking back at a group of patients -- are interesting, but they seem kind of misplaced at this point. They started long ago, I know, so they need to be finished and results need to be reported. But when the conclusion reads that immunochemotherapy [that is, Rituxan + chemo] is the best option when treatment is necessary, I think it speaks to some old-school thinking. I'd like to see people at least make a nod to some of the exciting stuff that's happening these days.