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Alert Number 144

FCR Lite — The Goldilocks Dilemma

Date: January 12, 2006

This is then the crux of our problem: how to make sure the therapy we decide on is just right: not too heavy handed and causing a lot of collateral damage, nor too weak to do much good. CLL is not your average short-fuse cancer. In most cases it is not a ravening beast that must be killed at any cost. In fact, for the majority of CLL patients, it is quite possible to shoot yourself in the foot by opting for the most potent (and most toxic) therapy out there.

The good news is that there are many new options open to us. The bad news is that there are so many new and bewildering options that we have trouble making sense of it all. How are we to make the right choices? Before you throw up your hands in frustration, it is important to know there are some common threads, some light that is making the CLL landscape just a little easier to figure out. Some researchers are beginning to think outside the box and beginning to treat CLL as a unique cancer that does not fit the general stereotype, recognizing that it needs more finesse than the standard take-no-prisoners approach.

In our latest article, FCR Lite, we review a recently opened clinical trial at the University of Pittsburg Medical Center. We label this approach “FCR Lite”, in contrast to the more heavy duty FCR “Classic” combination pioneered at M.D. Anderson. The new trial has the interesting combination of a lot more Rituxan (including a two year maintenance phase of just Rituxan following on the heels of the usual six cycle induction phase), and reduced amounts of both fludarabine and cyclophosphamide overall. If you are looking for that perfect Goldilocks fit, this trial may be worth considering.

I would not have heard of this interesting trial but for a patient participant (and his spouse). It confirms once more that we all benefit when we share information. If you are participating in a clinical trial, or you would like us to review a trial that you are considering, write to us, tell us all about it. Send us the patient information documents you received. We will do our best to do a balanced review of the pros and cons. We are also scrupulous about protecting patient confidentiality. Your name will not show up anywhere, unless you want us to acknowledge you in public!

Be well,


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