By Peter Martin, MD
Rituximab is a chimeric (human-mouse) monoclonal antibody directed against the protein CD20 on the surface of B-lymphocytes and most B-cell lymphomas. Several clinical trials have demonstrated that rituximab can increase response rates, prolong remissions, and improve survival among patients with various B-cell lymphomas and is an FDA-approved drug. Interestingly, rituximab was developed during an era when our understanding of how monoclonal antibodies might work was relatively naïve. Obinutuzumab (GA101) is a newer generation anti-CD20 antibody that has undergone significant engineering to capitalize on new knowledge. In preclinical testing, GA101 appeared to work better than rituximab. Three clinical trials evaluating GA101 in patients with follicular lymphoma were presented at the American Society of Hematology (ASH) meeting this year.
Dr. Gilles Salles presented the results of a phase I/II study performed in France, in which patients with indolent non-Hodgkin lymphoma (mostly follicular lymphoma). In phase I of the study, patients were treated with escalating doses of GA101, while in phase 2, patients were randomized between two dose levels (high-dose and low-dose). Most patients had received prior rituximab. Overall, GA101 appeared to be well tolerated, with mild infusion reactions being the most common side effect. The results were encouraging, particularly in the high-dose group, but will need to be confirmed with a larger study and longer follow-up.
Dr. John Radford presented the results of the international GAUDI study, which evaluated the safety and efficacy of combining GA101 with CHOP or FC chemotherapy in patients with previously treated follicular lymphoma. Continue reading “Obinutuzumab (GA101), a New Generation Rituximab”
By Peter Martin, MD
Post-traumatic stress disorder (PTSD) is a chronic condition characterized by anxiety and re-experiencing of a particularly stressful psychological trauma. Typically, we associate PTSD with events like wars or serious accidents. There is increasing data, however, that survivors of serious medical illness can also be affected by symptoms of PTSD. Long-term results of a study designed to evaluate PTSD in survivors of non-Hodgkin lymphoma (NHL) were recently reported in the Journal of Clinical Oncology.
The investigators administered surveys to 886 individuals with a history of NHL. They found that 39% of patients experienced PTSD symptoms with 8% meeting diagnostic criteria for PTSD. In a follow up study performed five years later, 566 of the original group of patients responded to a second survey. The investigators found that roughly one-third of patients experienced persisting or worsening PTSD symptoms. Only 12% of patients had symptoms that resolved over the course of the study. People most likely to experience persistent or worsening symptoms of PTSD were those with a lower annual income and those that reported a negative impact from the cancer (e.g., appearance concerns, body changes, life interferences, worry).
These results are particularly concerning for two reasons. First, the assumption that cancer-related anxiety will improve over time appears to be flawed. Second, as the population of patients with cancer ages, and as cancer care becomes more expensive, we are likely to see an increase in persistent PTSD symptoms. Clearly, we need to find ways to improve the initial cancer experience and to intervene earlier in patients at risk of persistent PTSD symptoms. The statement “survivorship begins at diagnosis” appears to be truer than ever.