…or False Hope?

Seems the power of positive thought does not always work…  This is the latest PET scan, 6 month followup to first line treatment for Hodgkins lymphoma.  The spot in my chest has grown and new spots have emerged, signifying recurrence.

Unfortunately this means I will need more treatment to try to cure this "most curable" cancer.  We visited City of Hope last week, and the doctor seems good - she actually gave me options!

I was not ready to accept the standard protocol, ICE, which requires three day inpatient administration over 4 months with many side effects. This dr has offered a couple of trials on newer therapies.

The new drugs she offered are immuno type therapies, and listed on the website http://www.cancerresearch.org/cancer-immunotherapy/impacting-all-cancers/lymphoma

The targeted drug brentuximab vedotin (Adcetris®)—a monoclonal antibody linked to a chemotherapy drug—is approved to treat Hodgkin lymphoma in patients whose disease has failed to respond to other treatment and, as of August 2015, to prevent relapse following a stem cell transplant. 

Nivolumab (Opdivo®) is an anti-PD-1 antibody made by Bristol-Myers Squibb (BMS). Nivolumab was granted FDA “Breakthrough Therapy” designation status for Hodgkin lymphoma based on a cohort of patients in a phase Ib trial testing nivolumab alone or with ipilimumab (see below) for blood cancers (NCT01592370). In that trial, 87% (20/23) of Hodgkin lymphoma patients responded to the treatment. - 

so salvage chemo will be either Brentuximab or a combo of the two, either way much less side effects than ICE and much easier to administer (IV drip, no port)

unfortunately stem cell transplant is 3 weeks in the hospital and seems daunting - but I guess people get through it.

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So let's consider the past 6 months a brief "vacation" from this little adventure.  I will try to post some of the great things I have been able to do during this "vacation," with big hopes for more in the future...


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More on Brentuximab:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646316/

The ADC brentuximab vedotin was associated with manageable toxicity and induced objective responses in 75% of patients with relapsed or refractory HL after auto-SCT. Durable CRs approaching 2 years were observed, supporting study in earlier lines of therapy.

The ORR was 75% with complete remission (CR) in 34% of patients. The median progression-free survival time for all patients was 5.6 months, and the median duration of response for those in CR was 20.5 months. After a median observation time of more than 1.5 years, 31 patients were alive and free of documented progressive disease. The most common treatment-related adverse events were peripheral sensory neuropathy, nausea, fatigue, neutropenia, and diarrhea.

More on Hodgkins lymphoma treatment:  http://patient.info/doctor/hodgkins-lymphoma-pro

Primary resistant and relapsed classical Hodgkin's lymphoma^[7]

• Repeat biopsy is recommended for patients thought to have relapsed, and should be considered in those who have residual lesions after treatment. PET/CT is the preferred restaging modality after salvage therapy (high-dose chemotherapy).
• Autologous stem cell transplantation (ASCT) is the standard treatment for patients with primary resistant disease or with relapsed disease who achieve an adequate response to salvage chemotherapy. ASCT is not recommended in those failing to achieve an adequate response.
• The choice of a first-line salvage regime in patients eligible for ASCT should be based on individual patient factors. Regimens containing stem cell toxic agents (eg, carmustine and melphalan) should be avoided if possible until stem cells have been successfully collected and cryopreserved if ASCT is planned.