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Biotech / Medical : IDPH--Positive preliminary results for pivotal trial of ID -- Ignore unavailable to you. Want to Upgrade?

To: DMB who wrote (1475)	3/8/1998 9:49:00 PM
From: Maurice Winn	Read Replies (3) \| Respond to of 1762

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

To: DMB who wrote (1475)	11/13/1998 4:57:00 AM
From: Maurice Winn	1 Recommendation Read Replies (1) \| Respond to of 1762

bloodjournal.org This says "An analysis of prognostic factors showed that response rates were lower in patients with refractory disease, patients with lymphoma not classified as DLCL and patients with a tumor larger than 5cm in diameter. DLCL and MCL patients had response rates of 37% and 33% respectively." That tells me that Rituxan caused killing of billions of lymphoma cells without undue risk to the patient. Therefore it seems that my treatment of: Surgical excision, 3 x CHOP plus Rituxan, followed by Oncolym then cod liver oil, vitamin C, E and a good sleep is better than 3 cycles of CHOP and radiotherapy for a stage I diffuse large cell lymphoma. The 37% response rate they mention means that there are an awful lot of distant metastases which will be killed. Since there are no bulky tumors in the Stage I excised patients, they are going to get much better cure rates. Is that how you read those results? Since Stage 1A 2cm excised tumor, IPI0, Intermediate Grade, Diffuse, Large B-cell, Non-Hodgkin lymphoma patients age 21 have cure rates of 80%, it seems that by the addition of Rituxan to the usual therapy, this cure rate could be increased to around 90% or more. Not bad for not much cost and not much health risk. Thanks for any comments you might have, Maurice PS: Here is a bit of basis for cod liver oil maybe being useful in lymphoma though this article is talking leukemia. Vitamin D is also unpleasant for melanoma cells. bloodjournal.org