Chemo-Free Follicular Lymphoma Treatment Regimen Shows Promise in Phase II Clinical Trial

CaptureThe combination of lenalidomide and rituximab may represent a reasonable alternative to chemotherapy for some people with previously untreated follicular lymphoma (FL), according to a study led by Dr. Peter Martin, chief of the Weill Cornell Medicine and NewYork-Presbyterian Hospital (WCM/NYP) Lymphoma Program.

Dr. Martin collaborated with the Lymphoma Program’s Drs. Jia Ruan and John Leonard, along with experts from academic medical centers across the country, to evaluate the non-chemotherapy drug combination in a phase II trial known as CALGB 50803, the results of which were recently published in the Annals of Oncology. The formalized collaboration was made possible by the Alliance for Clinical Trials in Oncology, a cooperative group sponsored by the National Cancer Institute (NCI).

Lenalidomide plus rituximab was administered over twelve 28-day cycles to 65 adults with previously untreated follicular lymphoma. Seventy-two percent of patients achieved a complete response. At five years, the overall survival rate was 100 percent, and 70 percent of patients remained free from disease progression. Rates are comparable with those typically produced by standard chemotherapy.

The study also demonstrated low rates of hematologic toxicity, such as neutropenia (low white blood cell count), lymphopenia (low lymphocyte levels) and thrombocytopenia (low platelet count), but low-grade side effects like fatigue, constipation, diarrhea and rash were commonly reported.

The results of the CALGB 50803 study do not definitively establish whether lenalidomide-rituximab is more or less toxic or more or less effective than a standard chemotherapy regimen; such insights will be clearer following completion of the randomized phase III RELEVANCE trial, which compares lenalidomide-rituximab to chemotherapy plus rituximab.

Optimal use of chemotherapy requires a careful balance of anti-tumor activity with tolerability. WCM/NYP is proud to be a leader in the discovery and development of therapies that are both active against cancer and well tolerated.

Emergency Preparedness for People with Blood Cancer

In the past few weeks, devastating hurricanes have forced people out of their homes and away from their cancer care facilities, highlighting a need for better education and preparedness surrounding the medical consequences of natural disasters. Emergency situations such as a hurricane, earthquake, blizzard, flood, or blackout, are unpreventable and can drive a city into disarray in a matter of hours – but the more preemptive thinking and planning that people do prior to a catastrophic event, the better equipped they will be to respond. This is especially true for people with cancer, who must be particularly cautious during such times, as they are often more susceptible to infection or injury.

Debri in road during typhoon

Follow these 5 tips to help minimize the harm that a natural disaster or public emergency can cause to your personal health:

Travel with Caution
Since extreme weather can cause travel delays both on roads and throughout public transportation, be sure to allow extra time to make it to your appointment safely. You may also want to consider staying in a hotel near the hospital to avoid hazardous commuting conditions before and after your appointment, especially if you’ll be in and out of the facility more than once within a few days. Some programs, such as the American Cancer Society Hope Lodge in Manhattan and Extended Stay America’s Hotel Keys of Hope help to alleviate the financial burden of traveling away from home to receive treatment by offering guest rooms for people undergoing cancer care. If you are uncertain about travel conditions, call Weill Cornell Medicine and NewYork-Presbyterian’s (WCM/NYP) emergency hotline at 212-746-9262.

Stay in Touch
If you are due for an infusion or injection during an episode of severe weather or other emergency, contact your doctor to discuss the risks versus benefits of finding a safe way to get to WCM/NYP’s treatment center, finding an alternative temporary treatment center, or possibly delaying treatment. In case you do need to seek treatment at an alternative facility, reach out to your insurance provider for help, and bring your insurance card with you to any clinical visits.

Know Your Info
Be aware of your exact diagnosis and disease stage, as well as where you are in the chemotherapy or radiation treatment cycle (if applicable). If you are a participant in a clinical trial, know the trial number, principal investigator (PI), and treatments involved. Should you forget any details pertaining to your medical records, you can easily consult Weill Cornell Connect, WCM/NYP’s secure online health connection that allows you to communicate with your doctor, access test results, request prescription refills, and manage appointments – anywhere, anytime.

Power Through Outages
Power outages frequently accompany extreme weather conditions, and it is vital to prepare accordingly. In the event that you cannot charge your mobile devices or access the Internet, you will want to have physical backup of important medical information, so record the names and dosages of all the medications you take, and keep copies of prescription slips that contain your health care providers’ names and contact information. Also note that some medications that require refrigeration may lose potency in temperature variation. In the event of a blackout, they should be replaced as soon as possible.

Pack the Essentials
Keep a first aid kit including basic essentials like extra bandages and gauze compresses, antiseptic wipes and ointments, over-the-counter pain relief medicines, and 3-4 days’ supply of any oral medications you may be required to take. Medication in its original container may be subject to contamination if exposed to flood water and is best stored in a sealable bag (Ziploc, for example) ahead of a natural disaster. Look to replace any medication that does not appear dry.

In general, but especially after severe inclement weather, be sure to communicate with your cancer care team if anything out of the ordinary happened (such as running out of medication or receiving treatment at an alternative facility) during the emergency episode so that they can update your medical records.

All of the physician practices at WCM/NYP have coverage 24 hours a day, 7 days a week, but even in the rare event that the outpatient center is closed, the emergency department will likely be open. In the case of a medical emergency, dial 212-472-2222 or 911.

Wishing everyone a safe fall and winter season!

FDA Approves Copanlisib for Certain Types of Follicular Lymphoma

The United States Food and Drug Administration (FDA) recently granted accelerated approval to copanlisib for treatment of adults with relapsed follicular lymphoma (FL) who have received at least two prior lines of therapy. Copanlisib is a kinase inhibitor that works by blocking some of the enzymes responsible for cancer cell growth.

The FDA’s decision is based on favorable safety and efficacy results in over 100 patients around the world as part of the CHRONOS-1 clinical trial.

Instead of having to wait years to learn whether a drug actually extends survival for cancer patients, accelerated approval enables the FDA to more quickly approve drugs that fulfill an unmet clinical need for serious conditions. Scientists look to measure surrogate or intermediate clinical endpoints – like tumor shrinkage, for example – that indicate whether a drug is reasonably likely to predict clinical benefit.

As a condition of accelerated approval, a randomized control (comparison) trial will be required to verify the clinical benefit of copanlisib before it can move on to help relapsed follicular lymphoma patients whose treatment options are often limited.