Greg, DMB etc, we didn't find someone in San Diego who advised Rituxan for Stage 1A, diffuse, intermediate grade, large cell, excised, 20mm cervical node excized in a 21 year old otherwise super healthy male.
Dr Saven at Scripps Clinic said that he would not use Rituxan in this particular case, even in a relapse situation, because far more effective chemotherapies are available, it is not proven to be effective on intermediate grade NHL, the prospects of not having the disease return are 80% to 90% plus, and there are some risks with Rituxan. He said that he had had a couple of cases of tuberculosis after using Rituxan. Which of course is not especially fatal compared with lymphoma.
Since I'm an ignorant bystander, I have to defer to his judgement, which all medical people seem to agree on. The Rituxan statistics up till December bear them out substantially, though no doubt there are some more accurate statistics starting to come through as swarms of people start using it for on and off label use.
Defer or not, I still remain unconvinced that it would not have helped in this particular case. The risks seem negligible and the benefits seem significant, in the realm of maybe another 5% prospect of survival for Tarken. Which is not to be sneezed at.
He commented that it was surprising that Rituxan was effective at all. He also said that shrinkage of a tumor was not the end story because he can shrink tumors fairly easily with, I think he said, steroids. But that doesn't actually rid the patient of the disease.
So the outcome is that Tarken is being nuked with high energy X-rays to the sum of 40 Gray, with concomitant salivary damage, thyroid destruction, thyroid cancer risk, leukaemia risk [leukemia in USA I gess] and other things. But no Rituxan!
I'd rate Dr Saven's competence highly and I'd say Rituxan got a reasonable chance at being used.
So it is 1970s therapy, [cyclophosphamide etc, xrays], cross fingers and hope!
Thanks for your previous comments,
Maurice |
