Davis, thanks for the technical stuff. 6-9% complete remission from Rituxan? Okay, if I was one of those I'd pick Rituxan over the radioactive types. So the issue is, how do you know which category you are in before the treatment? I don't believe in magic, but I also realize that human chemistry is so confusing and complex that it is easy to see it as magical.
If you have P53 mutations on exons 5 through 8, you are really in dire straits with chemotherapy, which will almost certainly fail. See "Blood" November 15 edition at:
bloodjournal.org
The Rituxan must work on some category of the NHL. Once they identify the category of CD20 antigen it works on, then they will always use Rituxan. No need for radioactive treatment if the clean one works.
That still leaves 90% needing treatment. Once primary treatment using Rituxan targeted to the cancer cells guaranteed to be killed is adopted, the success rate would rise to maybe 30% since the mutations leading to Rituxan resistance wouldn't have occurred [I'm making this up as I go as a hypothesis, not asserting it as fact]. So far it has been used on refractory and relapsed only. Those are in the hard basket before Rituxan is tried. Why wait until then? No reason at all. Climb back up the cancer chain and get it before the mutations which make Rituxan ineffective have occurred.
Y2B8 although bone damaging, causes less collateral damage than I131. I don't know what 40 mci is. Nor hama! I better go read some more.
While CD20 is less common in higher grade NHLs, treatments should be used only where they'll work. So the non-CD20s could get other treatment, the CD20s [or whatever the success marker is] could get the Rituxan.
Thanks again for the summary,
Maurice
PS: You're welcome to post my FDA rant to the FDA and anywhere else you choose! Glad you like it. |
