Pa­tients with re­cur­ring Hodgkin lym­phoma find new hope in im­munother­apy

The Philippine Star - - LIFESTYLE -

At a can­cer-treat­ment fo­rum held re­cently at the Crowne Plaza in QC, hema­tol­o­gist Dr. Daryl Tan, di­rec­tor of re­search at the Raf­fles Hos­pi­tal in Sin­ga­pore, nar­rated a bleak tale: a 25-year-old woman, in the prime of her life, was los­ing her bat­tle against a blood can­cer called Hodgkin lym­phoma.

“It’s a com­mon can­cer in her age group,” said Dr. Tan, “but most pa­tients — up to 80 per­cent —usu­ally re­spond very well to chemo­ther­apy. Un­for­tu­nately for this pa­tient, she was one of the 20 per­cent who do not re­spond well. Af­ter she com­pleted chemo­ther­apy, she re­lapsed. Her can­cer came back.”

Hav­ing ex­pe­ri­enced lit­tle suc­cess with chemo­ther­apy, the pa­tient re­ceived the stan­dard next line of treat­ment in Sin­ga­pore for her con­di­tion: stem cell trans­plant.

The treat­ment, how­ever, was un­suc­cess­ful. The pa­tient’s dis­ease con­tin­ued to progress and a huge tu­mor grew in her chest.

Dr. Tan dubs this sce­nario a “med­i­cal fu­til­ity,” where a pa­tient de­gen­er­ates de­spite med­i­cal ef­forts. At this junc­ture, Dr. Tan said that spe­cial­ists would nor­mally shift to a dif­fer­ent strat­egy where the aim is to let the pa­tient go peace­fully.

For­tu­nately at that time, a new type of treat­ment for Hodgkin lym­phoma was ap­proved in Sin­ga­pore. It was called im­munother­apy and in this par­tic­u­lar sit­u­a­tion, it was ap­plied through an im­mune check­point blocker called pem­brolizumab. This treat­ment was pre­scribed to the pa­tient at a time when there were al­most no op­tions.

“Af­ter two months, her tu­mor re­solved. Since then, she has been con­tin­u­ously re­ceiv­ing im­munother­apy and has been ex­pe­ri­enc­ing its med­i­cal ben­e­fits for one-and-a-half years. Now, we are happy to say she is back at work,” Dr. Tan re­ported.

WHAT IS HODGKIN LYM­PHOMA?

Hodgkin lym­phoma is a can­cer of the lym­pho­cyte, one of the five main types of white blood cells. The can­cer is most com­mon among adults in their 20s and 30s and un­like lung can­cer, which has been very clearly linked to smok­ing, its pre­cise cause is still un­known.

In its early stages, Hodgkin lym­phoma may show no symp­toms, but when it does, they are usu­ally in the form of swollen lymph nodes.

“Pa­tients usu­ally come to us be­cause they feel a lump in their neck, and then we send pa­tient for lab tests, and that’s when we find the can­cer,” Dr. Tan said.

Be­fore im­munother­apy was in­tro­duced, the con­ven­tional method of treat­ing Hodgkin lym­phoma was chemo­ther­apy, which uses drugs that are toxic to can­cer cells. How­ever, these drugs can also af­fect healthy cells, el­e­vat­ing the risk of side ef­fects such as hair loss and di­ar­rhea.

Im­munother­apy, on the other hand, helps the body’s own im­mune sys­tem and strength­ens it to fight the can­cer.

“We found that in Hodgkin lym­phoma, the body is un­able to fight the can­cer be­cause the can­cer pro­duces a pro­tein that sup­presses the pa­tient’s im­mune cells and pre­vents them from fight­ing the can­cer. With im­munother­apy, “we found that in Hodgkin lym­phoma, the body is un­able to fight the can­cer be­cause the can­cer pro­duces a pro­tein that sup­presses the pa­tient’s im­mune cells and pre­vents them from fight­ing the can­cer. What im­munother­apy does is it breaks this in­ter­ac­tion be­tween that pro­tein and the im­mune cells, so now the im­mune sys­tem is again able to en­gage and at­tack the can­cer cells,” Dr. Tan says.

A NEW TREAT­MENT OP­TION

Al­though Pem­brolizumab has only been ap­proved for the treat­ment of Hodgkin lym­phoma less than two years ago, it has al­ready been around for more than four years and has been ear­lier ap­proved for the treat­ment of lung can­cer and melanoma.

“We found, though, that peo­ple with Hodgkin lym­phoma re­spond even bet­ter to im­munother­apy than pa­tients with melanoma or lung can­cer,” Dr. Tan shares.

The cur­rent rec­om­men­da­tion is for pa­tients to con­tinue re­ceiv­ing treat­ment un­til they and their doc­tor see that the can­cer has not pro­gressed for two years. De­pend­ing on the can­cer though, some doc­tors have re­ported stop­ping at six doses and find­ing that the ef­fects of the drug en­dure. In other words, the can­cer does not come back.

Tan elab­o­rates, “Stud­ies on im­munother­apy drugs have shown suc­cess rates of over 70 per­cent where tu­mors be­come smaller, and some pa­tients have com­plete re­mis­sion, mean­ing there is no ev­i­dence of the tu­mor left in the body. For pa­tients like mine, where we have run out of op­tions, a drug like this that is able to give a 70-per­cent re­sponse, is a most wel­come ma­jor ad­vance­ment in medicine.”

In the Philip­pines, im­munother­apy is al­ready ap­proved for the treat­ment of non-small cell lung can­cer. Ef­forts to bring knowl­edge of it to the pub­lic, as well as to push for in­creased ac­cess to the treat­ment, have been steadily strength­ened by con­cerned groups and or­ga­ni­za­tions, which in­clude mem­bers of the med­i­cal com­mu­nity and ad­vo­cate pa­tient groups.

For ex­am­ple, im­munother­apy ad­vo­cates, such as the “Hope From Within” coali­tion, a multi-stake­holder col­lab­o­ra­tion that el­e­vates the fight against can­cer, is work­ing on its new game plan that would in­clude pro­mot­ing aware­ness, preven­tion, screen­ing, and im­munother­apy treat­ment for Hodgkin lym­phoma, ad­vanced melanoma, and head and neck can­cers.

Mem­bers of this coali­tion in­clude the Depart­ment of Health, Philip­pine So­ci­ety of On­col­o­gists, Philip­pine So­ci­ety of Med­i­cal On­col­ogy, Philip­pine Al­liance of Pa­tient Or­ga­ni­za­tions and health­care com­pany MSD in the Philip­pines.

Dr. Daryl Tan, a hema­tol­o­gist, is also the di­rec­tor of re­search at Raf­fles Hos­pi­tal in Sin­ga­pore.

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