Thursday, January 29, 2009

It's different in New York

This is a pretty technical post, so if you aren't part of the CLL crowd, you may want to skim it.

The lecture last night was refreshing and balanced. I even earned an hour of CME and ate mediocre steamed vegies on couscous.

Because it was accredited, the speaker was not pushing just a single product. Dr Weiss is from Sloane Kettering in NYC and he was a very good lecturer. With some very gutsy honest takes on some of the contradictions in results.

His take in the low response rate in the recent community based pentostatin study was that it was just a lousy study. As I suspected the wrong doses of both FCR and PCR and too many cycles of PCR resulted in increased toxicity.

His take on why MDACC gets such great results: They get healthier, younger patients. It is not that they cherry pick their patients. Their patients are young enough and rich enough to travel to see them. Their patients cherry pick them. Also in their first F study as a single agent they DID NOT DO BONE MARROW BIOPSIES TO ASSESS THE RESPONSE.  It is a lot easier to get a complete response with one eye closed. The blood is a much easier target than the marrow.

Finally he spoke about lenalidomide as a maintenance agent, using the lowest effective dose, instead of the  highest tolerated dose. He said it gets more effective the longer you use it.  That is so unlike most chemo in which the cancer sadly becomes increasingly resistant over time. CLL  is treated more like a chronic disease, like diabetes. Go slow and low and long. Tumor flare is a big issue when first starting, and can be fatal.

Finally, one last point. I was the only family doctor in a room of oncologists last night. Keep in mind that there are about 15,000 new cases of CLL a year and about 15,000 oncologists in the USA. That means your community cancer doctor is seeing one new case a year. Unfortunately that lack of experience showed around the room. See a CLL specialist, at least in consultation. Some of these very busy doctors are not up to date on CLL. How could they be with all the breast and colon and lung cancer they see? That is why, to their credit, they were there last night. To learn, and to get a free meal.



Blogger TomD said...

What was odd about the MDA studhat their results were worse than the results Mayo presented at the same conference. As was explained to me by a PCR researcher, both the dose and patient set accounted for the terrible results. Thanks for the report.

January 31, 2009 at 12:05 PM  
Blogger Barry B. said...

You write:
"Their patients are young enough and rich enough to travel to see them. Their patients cherry pick them."

I'd write, "Their patients cherry-picked themselves."

BTW, Revlimid has a poor response rate, less than 50%. Perhaps it will be better used as a 'maintenance' drug, though it's really too early to safely conclude that.

February 2, 2009 at 8:04 PM  

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