Gregory, "Needed in a week or so to catch low neutrophil levels before they start racing up again." By that I meant, guessing, that it would be best to use Rituxan when B-cells are already at their low ebb because of chemotherapy, when there would be fewest malignant cells still in business. By waiting until B-cell levels had risen again, there would be more cells, so the chances of Rituxan getting them all would go down.
I wasn't suggesting that neutrophils would have a detrimental effect on the Rituxan or its operation.
How come Rituxan isn't yet in your armory? It was approved by the FDA and production is well underway and sales are already in the multimillion dollar range.
On the risk business, ie should somebody be treated with Rituxan when they have maybe 80% home free, clear and cured chances, it depends on the expected danger from the Rituxan. I find it pretty difficult to believe that maybe 10% of people would suffer death or equivalent suffering by being Rituxan treated. If Rituxan gives that extra level of cure rate, then it is worth using.
The only serious side effect I've seen mentioned is the prospect of autoimmune problems which a doctor here claimed can be caused by Rituxan. Nobody has confirmed that. Maybe he is wrong. But even if right for 2% of people, so what! That is still an odds improver.
A problem I have with this odds business is that it is all wrong. There are no statistics apply to individuals - every one is indulging in an experiment. The odds business is simply a measure of our ignorance. What is really needed is to know exactly who will get cured, why; by what mechanism. Is it CD20 or P53 mutation expression? Allele 6 being a bit wonky? Some virus linked to a DNA specialty of the person involved. All that sort of stuff. But I understand that there is a bigger pool of ignorance in the medical profession than there is knowledge, so that is the best we can do for now.
Until we can say 100% I won't be happy. So I won't be happy ever. But that's life. We seek 100%. Living things are designed to aim at 100%. Anything less is on the road to evolutionary obliteration. So there is plenty of room for improvement!!
My opinion is that the doctors here have got it wrong. Tarken had a 1cm lump, which they managed to let get up to 2cm over a 4 week period before excision despite me ranting around the place to take it out quick smart. Hardly bulky disease. By radiating with 40 Gray, instead of Rituxan, I reckon they are barking up the wrong tree. By your statistics, that will give a negligible extra cure rate, but 100% certainty of radiation damage, with some chance of serious radiation damage to the thyroid.
Rituxan by comparison, would give something like a 10% improvement. At least, being very early stage, non-bulky. It seems to me, in the absence of any real prospect of serious side effects from Rituxan to be negligent to use radiation instead of Rituxan. What are the worst effects of Rituxan that can be expected? Even theoretical ones which might show up when greater numbers of people are treated with it.
The other silly thing about this is that there is no method of finding any residual disease. Or even definitively diagnosing the disease in the first place. In studies to investigate the accuracy of diagnosis, they have a committee of 5 experts reviewing diagnoses by other doctors and for many cases they need to vote on the actual classification!!
It's all pretty dodgy stuff. Roll on DNA analysis, gene chip screening, laser whatsit diagnosis etc. There must be residual malignant cells in the blood stream which would be a better way of finding residual disease than gazing with bleary eyes at yet another cat scan. Let's face it, with slices 1 cm apart on a cat scan, they can't even see things less than 1 cm diameter in many case. So they find plum size tumors instead of the littlies. By which time it's all a bit late.
Okay, there is a bit more!
Thanks Greg for the comments. Without knowing which people benefit or are harmed from the radiation which gives 5%-10% improved cure rate, I guess you are better with that as there are only about 1% substantially harmed from it. Tarken's one is an even tougher call as there must be only a 2% chance of improved cure rate from the 40 Grays in the cervical area when there is no tumor evident to shoot at. There is as likely to be one elsewhere - which would be got by Rituxan!!
Maurice |
