tag:blogger.com,1999:blog-19490962.post6326662520216145514..comments2023-12-10T10:06:41.979+00:00Comments on mutations of mortality: Early stage treatmentTerry Hamblinhttp://www.blogger.com/profile/06346629921055055879noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-19490962.post-14755442764843569092007-12-19T09:00:00.000+00:002007-12-19T09:00:00.000+00:00Early treatment carries the risk of treating peopl...Early treatment carries the risk of treating people who will never need treatment otherwise. These patients will do worse than those who never get treatment. On the other hand there are some patients who will benefit from early treatment, and these two will balance out. However, I think these early trials are of little value now, because we have new drugs and better ways of predicting what will happen to individual patients.<BR/><BR/>There are no studies such as you suggest.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-7724796848797056432007-12-19T06:58:00.000+00:002007-12-19T06:58:00.000+00:00You say treating early or late makes no differenc...You say treating early or late makes no difference to overall patient survival. <BR/><BR/>Now treatment takes a toll on normal as well as cancerous cells and leaves patients open to infections (viral and bacterial). It can also trigger some transitions to AIHA and other more serious complications and possibly death.<BR/><BR/>Since there is no difference in overall survival between early and late treatment does this mean that late treatment is somewhat less effective than early treatment, to keep the books balanced?<BR/><BR/>Have there been any studies to see if length of remission after treatment is correlated with doubling time measured before treatment?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-73837232550002924142007-11-13T16:11:00.000+00:002007-11-13T16:11:00.000+00:00I can go with a study of 2 'bad' markers novel tre...I can go with a study of 2 'bad' markers novel treatment using historical data as the 'other' arm of the trial, but I can't see the benefit to starting treatment before the conventional intiation point. anything that extends that 'no treatment' time is a bonus, since treatment has other detrimental effects on health. JHB.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-84480177767189191282007-10-25T12:41:00.000+01:002007-10-25T12:41:00.000+01:00Dave your answer is 23.Jenny-Lou. The only drawbac...Dave your answer is 23.<BR/><BR/>Jenny-Lou. The only drawback with Campath is its failure to penetrate large lymph node masses, so that would be a contraindication.<BR/><BR/>Anonymous. Thanks for the information on 'nought' I'm surprised that it is not understood by Americans. It is certainly the most commonly used word for zero in the UK.<BR/><BR/>Of course we cannot control subsequnt treatment. I assume that whether treated early or observed, the next treatment will be the best availavble. Progression-free survival would not be an adequate test because it would hardly be a surprised that untreated patients would show progresion first. The point about early treatment is to make patients live longer. If they don't then there is no point in doing it.<BR/><BR/>I am not convinced by the MD Anderson data on FCR because a far higher proportion of patients receiving FCR were stage I and II compared with their own series receiving FC. Apparently better results might be due to less ill patients. Next year we should have some definitive head-to-head results. If FCR shows an improvement in PFS over FC it will become available on the NHS.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-42504180303512159472007-10-23T05:59:00.000+01:002007-10-23T05:59:00.000+01:00First things first...'Nought'? Hmmm, how about 'n...First things first...'Nought'? Hmmm, how about 'none' or 'zero'? Nought is such an 'English' word that my spellcheck program marks it as a misspelling.<BR/><BR/>On to your study.<BR/><BR/>How can you control for subsequent treatment? Even if all of these patients remain with your trial site, differences certainly will remain as to when a patient needs subsequent treatment. I submit that it would be unethical not to allow your study patients freedom in selecting diverse treatment options.<BR/><BR/>However, since there are few such options in the state-run health plan (NHS), maybe that isn't a big problem in England. It would be in the US. Different subsequent treatments would mean that your statistics using over-all survival would be meaningless. I'd suggest treatment-free survival as a better end point. That would also be more ethical in my book.<BR/><BR/>Unlike most of you all, I have less of a problem with historical controls. Variables tend to even out as the sample grows larger and larger. Take MD Anderson's use of FCR, which I'm sure they consider the 'gold standard'. Given the numbers of patients they have treated with this regime (and given the length of time it has been used), it seems obvious that if non-subtle improvements in survival are apparent, that is a strong argument that FCR is superior to other treatments in use even today.<BR/><BR/>The use of single agent Campath is somewhat ethically unjustifiable, given that FCR does give superior complete remissions and over-all response rates than does single agent Campath. But perhaps FCR isn't offered by the NHS. Too expensive.<BR/><BR/>I suppose if you find enough patients who are willing to live by your rules, the results might be quite interesting. You could authoritatively state whether early Campath did improve survival.<BR/><BR/>It's certainly a long-term project, so there is job security as well.<BR/><BR/>Would I sign up for it? Very possibly yes, if I had the freedom to decide myself what my second-line treatment would be.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-44450917806090621422007-10-23T01:09:00.000+01:002007-10-23T01:09:00.000+01:00Second thought on this "early stage treatment". I...Second thought on this "early stage treatment". I really have a hard time understanding giving a protocol for CLL that has been proven not to be long lasting. I understand that at this point we can only do palliative care. So--the,"cure", if there ever is one, will come from a trial. So--I believe that early stage treatment for patient's with aggressive marker's is the smartest approach. We already know that there is a low life expectancy with this group. I remember seeing a chart that you did Terry, on unmutated patients that had a straight line to zero at 14 years from dx. Is that correct? So, you see, when one is dx at the age of 49--should we wait like Kurt did? I don't believe so. We know the outcome of watching and waiting. The jury is still out on early stage treatment and therein lies the advantage. What I am amazed about is that every single researcher/Dr. is not jumping on this immediately. Please don't debate the precious time we have left to death. That's my view and I'm sticking by it. Thanks Terry, for posting this.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-59345865973358388312007-10-22T18:28:00.000+01:002007-10-22T18:28:00.000+01:00Terry,This is the information that I am following ...Terry,<BR/>This is the information that I am following like a watch dog. Early intervention for the "aggresive" CLL. Tom will be one of the cller's in future data. He was dx in Dec. 2003 and started FCR3 in April 2004. He hit a nodular PR, slowly backing into a PR and now is relapsing with swollen liver and 3 lymph areas swollen, sweats, fatigue and a possible reactivation of either mumps or EBC virus. He is Zap70+ at 40%, done at UCSD, unmutated at 98.4% and although at dx his CD38 was 1.4%, it is now in the high 20's. It has climbed higher with every flow since FCR. Next treatment in Feb/March or as soon as it is released will be Revlimid plus Rituxan. Interesting side is that his lymphocyte count is still fairly low---the issue seems to keep coming back to SLL. <BR/>For your study, I would suggest Campath to be the drug involved.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-8142087744174640642007-10-22T17:41:00.000+01:002007-10-22T17:41:00.000+01:00Thanks for the post, it was very informative. I wa...Thanks for the post, it was very informative. I was curious, in the patients with only one unfavorable marker, how many of these had unmutated as their only poor indicator? The question has special interest to me since I have no poor prognostic factors except that I am only 1.7% mutated. Thanks for any info.davehttps://www.blogger.com/profile/15924920136898770828noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-15576094109021299502007-10-19T13:30:00.000+01:002007-10-19T13:30:00.000+01:00Clearly for young patients with so-called "high-ri...Clearly for young patients with so-called "high-risk" CLL such studies are important, Studies going forward clearly should include patients with 17- and may need to be designed so the results can be compared statistically to accepted regimens such as FR orFCR or HDMP+C,<BR/><BR/>The other question that needs to be addressed is the utuility of such therapy as a prelude to SCT or other potentially curative therapies (ie, vaccines or TCell engineering) that may becime avaialable in the future.<BR/><BR/>As A 56 yo man with "high-risk" CLL and an ever increasing ALC I find the lack of data appalling.<BR/><BR/>EBZAnonymousnoreply@blogger.com