Author: lymphomaprogram

Located on the Upper East Side of New York City, the Lymphoma Program at Weill Cornell Medical College/NewYork Presbyterian Hospital is internationally recognized for our efforts to enable patients with non-Hodgkin lymphoma, Hodgkin disease and related disorders to have the best possible clinical outcome, including cure when possible.

PYRAMID: A Personalized Medicine Study in Lymphoma

Update: this study is closed to enrollment. 

Pyramid Trial Background

With increasing knowledge of cancer biology and availability of new drugs, it is expected that therapy will be increasingly tailored to individual patients’ tumor subtypes. Examples of this in breast cancer, colon cancer and CML have emerged over the past ten years. Often referred to as “personalized medicine” or “precision medicine”, this targeted approach to cancer therapy relies on translational research that defines a drug’s clinical activity in the context of the tumor’s cellular and genomic pathology.

Translational research has characterized the molecular basis of the clinical heterogeneity in various lymphomas, and many new agents are in development for lymphoma. Although the targeted development of these drugs in specific lymphoma patient subgroups could potentially speed their availability to the right patients, there are two major challenges to targeted trials in lymphoma. First, the empiric clinical research has led to highly active drug combinations that improve outcomes for many patients with lymphoma and in some specific types current therapy does in fact successfully treat a portion of the patients; leaving fewer patients with an unmet medical need to enter clinical trials. Second, it is a practical challenge to test and quickly identify specific lymphoma patient subgroups that can be enrolled in clinical trials of targeted drugs. Therefore a personalized study should ideally use a practical, rapid test to identify a lymphoma group that is not responsive to known treatment and test a therapy that targets an important pathway in those tumors.

Pyramid Trial Summary

The PYRAMID trial addresses both of these issues in order to test an investigational combination of R-CHOP with or without VELCADE, a known NFKB inhibitor, specifically in non-GCB lymphoma. Continue reading “PYRAMID: A Personalized Medicine Study in Lymphoma”

Lymphoma in the News: Cigarette Smoking Associated with Hodgkin Lymphoma

By Peter Martin, MD

More bad news for smokers: A recent study published in the Journal of Clinical Oncology reports an association between cigarette smoking and Hodgkin lymphoma. The investigators evaluated 17 large cohort studies, involving over one million individuals and 285 cases of Hodgkin lymphoma. They found that current smokers had a 39% higher risk developing Hodgkin lymphoma. Among men, individuals older than 30 or 40 years old, those that smoked more than 20 cigarettes per day, and those that smoked for more than 20 years, the risk was even higher.

The good news is that former smokers did not have an increased risk of Hodgkin lymphoma, but this may have been due to inconsistencies regarding the way “former smoker” was defined in the cohort studies.

The authors conclude, “The health implications of tobacco smoke are vast, having an impact on almost every organ system. Smoking cessation will have a positive impact on public health and should be advised globally.”

 

Lymphoma in the News: Post-Traumatic Stress Symptoms are Common in Survivors of Non-Hodgkin Lymphoma

By Peter Martin, MD

Post-traumatic stress disorder (PTSD) is a chronic condition characterized by anxiety and re-experiencing of a particularly stressful psychological trauma. Typically, we associate PTSD with events like wars or serious accidents. There is increasing data, however, that survivors of serious medical illness can also be affected by symptoms of PTSD. Long-term results of a study designed to evaluate PTSD in survivors of non-Hodgkin lymphoma (NHL) were recently reported in the Journal of Clinical Oncology.

The investigators administered surveys to 886 individuals with a history of NHL. They found that 39% of patients experienced PTSD symptoms with 8% meeting diagnostic criteria for PTSD. In a follow up study performed five years later, 566 of the original group of patients responded to a second survey. The investigators found that roughly one-third of patients experienced persisting or worsening PTSD symptoms. Only 12% of patients had symptoms that resolved over the course of the study. People most likely to experience persistent or worsening symptoms of PTSD were those with a lower annual income and those that reported a negative impact from the cancer (e.g., appearance concerns, body changes, life interferences, worry).

These results are particularly concerning for two reasons. First, the assumption that cancer-related anxiety will improve over time appears to be flawed. Second, as the population of patients with cancer ages, and as cancer care becomes more expensive, we are likely to see an increase in persistent PTSD symptoms. Clearly, we need to find ways to improve the initial cancer experience and to intervene earlier in patients at risk of persistent PTSD symptoms. The statement “survivorship begins at diagnosis” appears to be truer than ever.