Research Highlights: Week of December 20, 2010

Beyond my own ramblings, here is an overview of some of the published work that may be of interest to people living with lymphoma, over the past week. I'm skipping over the recent material from ASH, which is of interest in itself. More on that later, perhaps, but there were plenty of interesting papers there, too. Here I look at the December 16 issue of Blood, the December 20 issue of the Journal of Clinical Oncology, December 2010 issues of the British Journal of Cancer, CA, Clinical Lymphoma, Myeloma & Leukemia, Lancet Oncology, and Leukemia & Lymphoma (as dense as always).

• Miscellaneous -- The American Society of Clinical Oncology's Annual Report on Progress Against Cancer is out. Special mention is given to new progress against lymphoma, including major trials of bendamustine and rituximab maintenance for follicular lymphoma, FDA approval for pralatrexate (Folotyn) for peripheral T-cell lymphoma, and approval for ofatumumab (Arzerra) for CLL. In addition, there is a new British survey trying to find out why cancer patients are reluctant to participate in clinical trials. The results indicate that younger patients and men are more willing to join trials, and (predictably) that what makes people most nervous is the randomization process.
• New Drugs -- The Lancet Oncology has the details on a Phase I trial of navitoclax, a potentially important experimental Bcl-2 inhibitor. Myron Czuczman, whom people with lymphoma may recognize from his work on monoclonal antibodies, is listed as second author. There was a 21% response rate with a median progression-free survival of about fifteen months. Remember that response figures from Phase I trials actually tell us very little about the effectiveness of the drug. Phase II trials will go ahead with the higher dosage assessed in this trial, which may yield higher response rates. Czuczman is also a co-author (albeit the twelfth author) of a trial of a new human monoclonal antibody, mapatumumab, which targets the TRAIL-R1 cell receptor. Only 6 of 40 patients (15%) responded, and 50% of these progressed within just two months. Results were most promising for follicular lymphoma patients: 2 complete responses, 1 partial response, and 2 with stable disease, with the latter remaining stable for about 2 years.
• Chronic Lymphocytic Leukemia -- An Argentine-South Korean study of decitabine in CLL was moderately promising, showing a 35% response rate with 71% survival after two years. However, several American Phase II trials of bevacuzimab, sunitinib, and AZD2171 (both kinase inhibitors) in CLL had dismal results: there were no complete or partial responses.
• Diffuse Large B-Cell Lymphoma (DLBCL) -- An American review looks at current treatment strategies as well as some new research into advanced inhibitors.
• T-cell Lymphoma -- A Taiwanese study looks at a rare form, angioimmunoblastic peripheral T-cell lymphoma, which predominantly affects the elderly, has 2-year survival rate of about 40%, and was traditionally treated with CHOP. This is a review of files starting from 1988, well before the era of monoclonal antibodies. A more limited Rhode Island study describes achieving complete remission in two adult T-cell lymphoma-leukemia patients using Hyper-CVAD.
• Waldenstrom Macroglobulinemia -- An Australian study found an encouraging 90% response rate to fludarabine in various combinations (including with rituximab, or F-R) in 27 patients. All 10 untreated patients had a response (100%), although only 1 achieved complete remission. An article review by Morie Gertz throws some cold water on this, noting that while fludarabine is an effective treatment for lymphoma, it compromises future autologous stem-cell transplants and appears to increase the risk of leukemia.