An Expert’s Upbeat Perspective on Progress in Lymphoma

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Dr. Myron Czuczman, chief of the lymphoma/myeloma service at Roswell Park Cancer Institute in Buffalo, New York, is feeling very positive about the latest developments in fighting lymphomas. In this thoughtful interview, recorded at the 2014 International Workshop on Non-Hodgkin Lymphoma (iwNHL), a gathering of leading experts, Dr. Czuczman traces remarkable progress in research and how it is giving many patients with lymphomas longer, fuller lives.

Sponsored by the Patient Empowerment Network, which received educational grants from Millennium Pharmaceuticals, Seattle Genetics and Genentech. 

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello and welcome to Patient Power. I’m Andrew Schorr.

Lymphoma experts from around the world gathered at the iwNHL—the International Workshop on Non-Hodgkin Lymphoma—and we were there to hear the latest and what it means for patients. One of the leaders of the meeting is also one of the leaders in the field, and that’s Dr. Myron Czuczman. He is from the Roswell Park Cancer Institute in Buffalo. He sat down with us to give us a very upbeat assessment of where we are now that gives real hope for patients.

Dr. Czuczman:

It’s actually one of the most exciting times that have occurred probably in many decades—with respect to what’s being developed and what we’re seeing coming down the line with respect to treatment with lymphomas. As we know, lymphoma is not just one disease. We have over 60 subtypes, so it’s very important to know that one size doesn’t fit all. But the excitement that’s generated with respect to what we’re learning not only with respect to what makes the cancer cell tick—it’s amazing how lymphoma cells, we’re now gaining more information with respect to what inside the cell actually allows it to grow and to survive and to actually—what I’ve been studying in the laboratory for years now—resistance. Why do these cells become resistant to some of these therapies, and how do we overcome that?

But what I think is very exciting is that we’re seeing these novel, targeted agents, most recently, drugs that have been approved include lenalidomide (Revilmid) with respect to patients with mantle cell lymphoma but also ibrutinib (Imbruvica), which is interesting. It’s an inhibitor of something called BTK–Brutons Tyrosine Kinase—an enzyme that if you can inhibit that enzyme, the tumor cells, the lymphoma cells can die—almost something that we wouldn’t have even imagined a few years ago. There’s also other agents; another enzyme against something called PI3K that is idelalisib (Zyedelig), which was just also approved in low-grade lymphoma with rituximab (Rituxan). But as I was going to point out though is the old days where we would just give patients toxic chemotherapies, they’re not very selective. They killed cells that were growing quickly, for example, but also killed a lot of normal cells. So the amount of toxicity was a lot more. Not to say that these novel agents don’t have toxicity, they do, but the patients’ quality of lives are better. We’re getting activity that, in some ways, is as good if not actually better with less toxicity and the quality of life of patients and outcomes—meaning not only the amount of time, for example, that they remain in remission. But also a number of patients now curing of patients is actually increased. What I can tell you is that there is this trend that also the utilization of biotechnology which allowed, for example, many years ago, rituximab to be developed, antibodies were the magic bullet. When I was still a younger lad with more hair, even in high school and before I even started college, I read an article, I can remember, in the Pittsburgh Press that said the magic bullet, monoclonal antibodies will cure all cancer, we’re not going to need chemotherapy. Well, that wasn’t the case ,and that was back in the ‘70s. But with the development of the new biotechnology and techniques and the ability to take a human antibody backbone and combine it with a mouse binding area is amazing what it was able to do, and it was exciting to be part of that. But now that is just amazing how it’s just continued to grow and grow. We have a lot of novel agents that we’re using, as I mentioned, now. But in addition to that, to take an antibody and with biotechnology to put—what the missing thing was, the missing link—there was a binder, a linker where you take a very powerful chemotherapy agent that you can’t give to a patient in their vein because it’s too toxic. But if you link it very tightly to an antibody, you can actually—I call it a pizza delivery system—you can deliver—the antibody delivers that very powerful drug to the cancer cell that has a target on its surface. But only in these type of targets it internalizes it so it brings the chemo therapy directly into the tumor cell, and it can kill the tumor cells. So you don’t have the non-specific—you don’t just give a big dose that goes through the whole body—it actually is much more specific to the tumor area. These type of things are so exciting and not just—we have certain types of chemotherapy agents used now—in the future there’s going to be even more, different of these payloads or these different bombs that we’re putting on them to deliver.

In addition to that is the immune system. The immune system was something that we knew was important. For example, in lymphoma, we did also understand that the reason that patients actually developed lymphoma is because very clear characteristics were a suppression of the immune system that could occur either with patients that were on medications, for example, on long-term medications for steroids or patients that underwent either solid organ transplants or say allogeneic bone marrow transplants they had to be on immunosuppressant agents that could actually increases the risk of developing lymphoma but also just getting older. We have a much older population and with respect as we age, our bodies are getting older including our immune systems which also allow the development of lymphoma. What is also interesting is that we don’t have the fountain of youth yet, we haven’t discovered that drug, however we are having the ability of trying to improve those deficits. And with agents such as–in the field, what we call IMiDs—Revlimid being one of them—immunomodulatory drugs, it really is interesting how they can stimulate, for example, parts of the immune system that are weakened such as T cells. Also another part of the immune system that’s very important is natural killer cells but also blood vessels that actually feed the tumor cells can be depressed. One drug, multiple types of activity, which actually is very exciting, then how to combine them? So targeting the actual microenvironment—we have a very exciting—at the meeting that we’re at here, the iwNHL—the first session we had was very exciting because different components of the immune system, if we can actually improve them, we can actually increase, perhaps, not only response rates but perhaps even cures in these cancer patients in lymphoma. And the other thing that we’re envisioning is that is very exciting is something called CAR T cells. We’re actually taking from individuals–ç don’t want to—it’s not quite ready for prime time, and I have many patients in clinic asking “can I have this treatment?”  Not quite ready, but it’s coming. And what that is is where an individual with, say, the CLL or lymphoma, you can actually take their T cells and actually educate them and target them, for example, a surface target, for example CD19 or CD20, which are on the majority of B-cell lymphomas. And then that patient’s own T cells go in, find the target and, actually, they’re activated and they can kill the tumor cell. So re-educating the weakened immune system, or taking the immune system that, basically—I tell patients—it’s kind of floating around, they’re not very intelligent, and educating these cells; giving them a college degree and have them go after and have them do what we really want them to do.

So the future is very bright, is very exciting. The number of therapies we have, in some ways, make it difficult, because getting the right combination, the right sequencing, which ones are best combined, we’re doing that, not only in the laboratory. But I think it also behooves us to, that our patients that are seeking novel therapies, that, if possible they can participate in these clinical trials because the more information—because as I tell with patients, I see a lot—we have building blocks. Before we can actually complete the building, we have to have a strong foundation, and part of that is the clinical trials that we’re doing. So it’s a very exciting time, and it’s actually very rewarding to be part of seeing this type of exciting research going on and participating in it. But at the same time, it actually gives us a problem that we now have to best figure out these exciting agents that weren’t there 30 years ago, how to best use them, I guess, but that’s a good problem to have.

Andrew Schorr:

Wow! A very upbeat message, of course. And take to heart the message he also gave us and consider also participating as a patient in clinical trials. It may give you the benefit of tomorrow’s medicine today and help so many others.

Be sure to be signed up for alerts on our website. We’re going to be posting a lot more programs in the lymphomas.

I’m Andrew Schorr. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on September 18, 2014