Any tips on alternative to MD Anderson?

ShadyGuy said:

Thanks

i cannot disagree with anything you say. However I believe we always have choices in that there are now several similar treatments to Rituxan. I have to wonder how they compare regarding side effects. Are there any ill effects from switching from one to the other? I know that Rituxan improves quality of life, I am certain of that. However, even though progression free survival increases, every study I have seen shows little or no improvement in overall survival. I take that to me mean that lifespan is minimally improved but quality of that life is enhanced. A very good thing. 

I've struggled with phrasing this, so if I don't make sense or if anyone thinks that I don't have it sort of right, please feel free to jump in.  Here goes:

Many chemotherapeutics are directed at specific cellular pathways and have their effect by acting on those pathways.  If the pathway is not in use, the chemo has nothing to act on.  The easiest example I can think of is cell division:  if a cell is dividing, a chemo that kills dividing cells can do so.  But if a cell is not dividing, the chemo has little or no impact.  This is why (in part) rapidly growing tumors are sometimes easier to knock out than slow growing ones. That new drug you were asking about in your other thread, Shady, can unblock a blockage in programmed cell death, allowing a cell on that pathway to progress to dying.  But a cell that is not on it's way down that pathway will not be killed by the drug, at least not via that mechanism.

The trouble with tumor cells is that they do not always behave the way that we would like them to. They can and do go "dormant" making them poor targets for many chemos.  If they "wake up" later on and there is no chemo around to knock them out, we relapse.  But now we have Rituxan, which is extremely well-tolerated relative to other stuff and which can be administered over a long period of time.  This agent acts on the outside of the cell using mechanisms that are not dependent on the tumor cell machinery, so it can act on a dormant/quiescent cell.  I say "Hurray for Rituxan!" because now we have something that can be kept in our system and catch any escapees or reawakees if you will  Yes, there may be problems and not everyone will tolerate it, but recall that rheumatoid arthritis patients stay on it for a very long time.

I am not on Rituxan but have had many of the same issues as Shady over the past year and a half, particularly fatigue and joints.  But I feel increasingly out of the woods.  Approaching my 70th birthday and took my first hikes in 2 years last week.  Normalcy is returning.  There is no question that if I overdo it, I regress.

I agree that PBL's comments were very spot on.

Hi All,

There is no doubt in my mind that all cancer research teams around the planet are actively looking for that silver bullet - the drug that targets cancer cells only, to the exclusion of all others. 

Until they do find it, Rituxan may be the next best thing. To phrase the above comments differently, it is, a bit like democracy, the least worst solution. At least, medical teams have twenty years' experience handling it, and, although it does not seem to offer a longer survival, it can be used repeatedly - unlike "traditional" chemotherapy drugs - and does allow us to keep on keeping on for as long as that lasts. May I add that Rituxan lingers a long time in our blood, and therefore, I am not sure that switching to some other monoclonal antibody would solve any adverse effect problems - I would suspect it might in fact make things worse by piling on more adverse effects.

To further Evarista's quite articulate (as usual) "random thoughts", I would add that combination chemotherapy regimens have been elaborated precisely because each drug only acts on a specific weakness in the armour of cancer cells.

Max, based on your anecdote, I believe your hematologist and mine must have learnt the same "tricks of their trade"! I have heard my hematologist speak at a medical conference and obviously have no doubt about his competences and knowledgeability. It just takes a bit of adjusting to medical men's mode of communication - which the generally long survivorship of lymphoma patients affords us...

Shady, you may simply need to remind your hematologist that you've had a bout of shingles after your last infusion, so that s/he can look more closely at your immunoglobulin levels, and put you on antiviral prophylaxis (if you'll have it) in order to avoid another outbreak.

PBL

From what I've gathered (heard and read), I have come to the conclusion that I'd have to have exhausted every other possibility before considering that. As I understand it, it may be very promising, but right now, it is not for the faint of heart. Hopefully, after some more tinkering, they may have more acceptable statistics... Talk about adverse effects!

PBL

Hey Shady, so my local oncologist who comes for clinics to my little town is out of Knoxville decided to send me to Sarah Cannon Cancer Center because he thought I would get better care there than Vanderbilt because of logistics of the chaos of the university. It is very close to Vanderbilt. I went for consult earlier than my appt because my neck swelling. I couldn't even partcipate in an approved clinic trial for CART due to the wait time. I was immediately admitted and had one(of 2) round of RICE in prep for my stem cell transplant that is scheduled for the month of Dec. I was very well taken care of. I love my new oncologist who is highly spoken of thru out the hospital. I have an actual team also. Just to warn you Nashville is a crazy town an during rush hour expect to take 2 hours to go 20 miles. We weren't quite prepared for that. Wanted to tell my experience in Nashville since you decided on Vanderbilt. Sarah Cannon (aka Minnie Pearl) Cancer Center is dedicated to cancer. All the best to you and the road you decide to travel. Lori