Mq - Your primary point - that it is unethical to deprive patients of the right to take all forms of potentially life-saving treatments - requires a treatise to do it justice. And I don’t (can’t) do treatises. But let’s talk about some of the details.
< it seems obvious [and has done to me for 3 years now] that Rituxan and Zevalin should always be used in CD20 intermediate grade NHL in conjunction with the traditional CHOP treatment.>
Well, I don’t know about “always”. The combo of Rituxan and CHOP are logical because they have different mechanisms of action and their toxicities do not overlap. And of course, Rituxan is always used with Zevalin, so that is sort of a combo. Ritux + Zev + CHOP? That remains to be seen. Zev and CHOP are both myelosuppressive so the toxicity would have to be carefully managed.
Even though Rituxan has been approved for 3 years now, it hasn’t displaced chemo as the standard for frontline therapy. Some intermediate grade NHL cases are cured with chemo. The oncologist establishment is not going to switch to other frontline treatments until its practicing docs are convinced that the new treatments offer prospects that are at least as good or better.
< I expect that Bexxar and Oncolym should also be used to kill any cancer cells which escaped the CHOP, Rituxan and Zevalin. The treatments should follow sequentially if they can't be given simultaneously, with reduced doses of the radiation-bearing treatment. >
Well, they certainly couldn’t be given simultaneously at the normally prescribed dosage! Bexxar, for example, requires pretreatment dosimetry to identify the prescribed dosage, so combining it with something else could make things pretty complicated. For sure, it will be many years before we see treatment with multiple radiopharmaceuticals (separate drugs or same drug with different radioconjugates). As I said before, what we ultimately need is a cocktail with multiple radionuclides selected for optimal energy deposition in tumors of varying size. You need the gorilla-like Y-90 betas to take out the bulky stuff (anything bigger than a few mm), and wimpy betas like I-131 shoots off to clean up the micro-metastases (which the high-energy Y-90 betas might pass right through without depositing their energy).
<That would give a much improved long term life expectancy for early stage NHL patients. It would do so because the probability of killing the last cancer cell would zoom right up! >
Hey, let’s throw in some ISIS 3521 and Targretin for good measure!
<It amazes me how hopelessly slow and incompetent the medical profession, research industry and FDA appear to be. Their ethics are obviously off-course since hordes of people are dying, having been untreated with the combination therapy which would have saved them from the scourge of NHL. The therapy obviously has near-zero risk compared with the risk from NHL cells [which escape CHOP treatment] and involved field radiation which is high dosage, but local only, which misses escaped cells
I wish some of these medical people would explain to me why the three year delay has been a good thing. They will call it due process. They'll claim 'safety' matters, ignoring the fact that Rituxan is a nearly riskless proposition and has obviously been so for several years. >
Two days ago, an FDA advisory committee gave a resounding thumbs down to Maxim’s Maxamine for treatment of liver-metastasized melanoma. Ok, granted the trial design was flawed, and it’s a far cry from a cure. But what impressed me the most was the committee’s obvious ill-will. We’re talking about terminal patients with a very short time to live. And they are being denied a treatment (a naturally occurring histamine, no less) that might, just might, extend and improve their lives somewhat. More than that, they are being denied hope. I guess this is part of the “due process.”
Come on IDEC, make it happen and fast. Quit messing about you oncologists and start giving people the treatment which will best maximize their lifespan and overall health during that lifespan. Get patients to sign a waiver if you are worried about using your medical expertise and good judgement. >
There are some provisions for compassionate use, but that requires getting enrolled in an approved clinical trial, etc. etc. It’s not the same as your power-to-the-patient approach.
Anyway, how come there isn't a bunch of people discussing IDEC in SI? There should be hordes of patients, investors and others all wanting to live or make a lot of money or both. >
Now that’s the one I really can’t understand! Maybe it’s because we’ve already achieved such a lofty valuation. C’mon folks, there’s lots to talk about! This has been some ride, but where are we going from here?
Rich |
