Saturday, May 17, 2014

ASH 2013: Dr. John Pagel Discusses Radio-Immune Therapy (RIT) in Chronic Lymphocytic Leukemia (CLL)

The big buzz at the ASH annual meetings for the last few years has rightly been targeted oral therapies such as ibrutinib and idelasib and other, but one therapy that in my opinion that has received short shrift is radio-immunotherapy or RIT.

In fact, it is so rarely used that since this video was recorded in December, 2013, Bexxar (Tositumomab) was pulled from the market in February, 2014 as it was prescribed fewer than 75 times in 2012.

Zevalin (Ibritumomab Tiuxetan) is still available.

At ASH 2013, I interviewed Dr. John Pagel out of the Seattle Cancer Care Alliance (the union of the Fred Hutchinson Cancer Research Center (the Hutch), UW Medicine, and Seattle Children's) who has a very patient friendly way of explaining how these drugs work and what their role might be. Dr. Pagel is also a kind and wise transplanter and as such has extensive experience with conditioning therapies that often include different forms and dosing of radiation to prepare for the transplant and that is another reason why I wanted to hear about his updated research on this important and neglected corner of CLL research. To understand how much or little we have moved forward in the last year, please check out my interview with Dr. Pagel done a year earlier at ASH 2012. As you can read, we are still dealing with the  some of the same old issues that are slowing our progress.

RIT makes most sense to me as a mop up  or "consolidation" therapy and as I have posted before, we desperately need that. I believe RIT should be explored as a final knockout punch to our CLL when it has been decimated and only a few active cells are hiding out in our marrow and our nodes.

I suspect that this research idea won't get much traction.

Dr. Pagel is too kind when he describes why these antibodies with their toxic payload are underutilized.

True they are expensive and tricky to administer, but they are usually a one or two time treatment. 

Sounds good to me. 

The real reason they are not used as much as they could be is that oncologists can not prescribe them. You need to consult a radiation oncologist and even then, the radiation oncologist you see may not offer that option or have much experience with RIT. It requires specialized set up for its administration and management. 

So basically it is a turf issue. 

Here is a link to the abstract that Dr. Pagel presented at ASH 2013.

And here is the interview. As I said as we talked, I love his analogies.

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Blogger Unknown said...

Interesting But....
I have a problem with any "new" therapy approach that targets healthy as well as cancerous cells. A ROR1 targeted drug delivery might turn my rotors more.

I would have been interested to hear John's take on the CD20 shaving or internalization phenomena that had been described by the work of Dr. Taylor. The documentation of stealth cells having no CD20 target after Rituximab Therapy to hone in on would seem to thwart the strategy. I suppose that the newer generation of CD20 mAbs that target the closer epitope of CD20 might avoid this issue but the use of CD20 mAbs as a first therapy should be discussed more.

great job pursuing the leads,


May 18, 2014 at 5:25 AM  
Blogger CJ said...

On a more uplifting note..I religiously read your blog and I cant tell you what it means to me and so many other, you're incredibly brave an inspiring..thank you so much for what u do, means more than you'll ever kno..god bless an keep up the good fight

May 18, 2014 at 10:18 AM  
Anonymous Anonymous said...

I've never heard of RIT thanks for bringing this to our attention Brian. It sounds promising although with radioactivity going through the blood and tissues, it seems off target harm would be a significant issue, at least to this untrained eye. I hope of course my gut is way off.

This is another frustrating example of the "CLL industry" atmosphere slowing a full steam ahead push on the most promising therapies, particularly in combo which is what CLL patients need most. A lot of unnecessary process friction and entrenched interests are adding years to our waits to see this stuff in clinic, and ultimately we know what that means in terms of lost patients.

May 18, 2014 at 10:19 AM  

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