PB, do you have an url for the ASH conference abstracts? Or other information on it in regard to NHL? Since not all intermediate or high grade lymphomas express CD20, the definition of the lymphoma needs renovation, as you suggest, away from medieval classification.
Doesn't CD20 mean Rituxan is likely to work and CD20 is the common factor, rather than whether the lymphoma is follicular, diffuse large cell or high grade?
Thinking about the mechanism, the most obvious place to use it is in early stage disease, where a primary tumor is excised, no other tumors are evident but there are no doubt some cells drifting around looking for a base to set up shop. Rituxan should work well on free floating, blood exposed cells, but not so well on necrotic tumors where blood supply and exposure to Rituxan is minimal.
The most useless place to use it is where they did the clinical trials = late stage, failed treatment, tumor riddled people. The best place to use it is in the beginning, when the disease is more vulnerable to damage by the immune system. In these cases, the best treatment would be chemotherapy to kill most, then Rituxan to clean up heaps more, then I131 to nail the rest. Yttrium 90 seems more relevant to tumors that to early stage treatment. It gives bone damage. I131 irradiates everywhere and since blood is everywhere, that seems okay. Too bad about bystanders - they can stand clear.
Yes? No?
There seem to be heaps of I131 competitors, such as Coulter, Techniclone and I suppose others. There are going to be a lot of products after the lymphoma dollar in 5 years.
Maurice |
