Category: Patient Education

Lymphoma Medicine is Precision Medicine: A Conversation with Dr. John Leonard

Last week, Dr. Leonard held a lecture to discuss how lymphoma medicine is precision medicine. Precision medicine treatment options are tailored to each patient’s specific genetic profile and medical history. With the availability of genomic sequencing tools, it is now feasible to profile a patient’s genome and locate the mutations that cause cancer.

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Dr. John Leonard

Each year more than 80,000 cases of lymphoma are reported, spanning over 100 different classifications. The majority of these are non-Hodgkin lymphomas. The most common forms of which are follicular lymphoma, diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic lymphoma, and mantle cell lymphoma. Although these are all subtypes of the same disease, the variances in their biology require different treatment approaches.

To illustrate the effectiveness of precision medicine approaches in lymphoma, Dr. Leonard cited the treatment of DLBCL. For patients with DLBCL, the standard initial treatments are the chemotherapy combination R-CHOP and dose adjusted R-EPOCH. Around 70% of cases are cured with either of these two treatments, proving that chemotherapy is effective.

The other 30% of patients who do not respond to treatment proceed to 2nd and 3rd lines of therapy. For patients whose DLBCL returns, there is only a 20% survival rate. This low survival rate for patients with recurrent lymphoma and patients who do not respond to chemotherapy necessitates different approaches to treatment. This is not an abandonment of effective chemotherapy, but a way to tailor treatment more specifically to the patient’s individual tumor biology.

Precision medicine in lymphoma treatment involves targeting the “cancer cell-of-origin” in patients, or in other words, the genetic source of the cancer. Through gene expression profiling, we are able to determine distinct molecular subtypes. This could allow us to detect malignancies earlier on and offer better preventative treatment for individuals at risk of developing blood cancer. Continued advances in our understanding of the genome fuels the growth of precision medicine which already plays an important role in treating certain lymphomas.

Although precision medicine is a huge advancement for the treatment of lymphoma, there are still challenges. This includes weighing the effectiveness of drugs used in targeted therapy, developing tools to categorize the different lymphoma subtypes, cost, and patient participation. Because it is a still a growing field, many precision medicine goals are still in the early stages of development.

Stay tuned for the American Society of Hematology (ASH) annual meeting in November where Dr. Leonard will be presenting new research regarding lymphoma and precision medicine. If you would like to learn more about precision medicine at Weill Cornell Medicine visit the Englander Center for Precision Medicine website. If you are interested in learning about the new innovative treatment options at Weill Cornell Medicine visit our JCTO website listing our open clinical trials.

Managing the Stress that Comes with a Lymphoma Diagnosis

trvinoBy Kelly Trevino, PhD

Being diagnosed with lymphoma is a jarring and life-changing experience. As one person stated, “the moment I heard the diagnosis everything changed. I left the hospital and the world was the same but it felt different. I felt like everyone else kept on going with their regular lives but I was in my own personal fog where time was slow.”

The first weeks and months after being diagnosed with lymphoma can be very challenging. You are given lots of information about lymphoma, the treatments, and the side effects. You meet oncologists and nurses. You have blood drawn. You sign forms. You may start treatment. It stands to reason that anxiety and stress are high at this time.

Anxiety consists of nervousness and worry and can manifest itself in physical symptoms like muscle tension and difficulty breathing. Anxiety is a normal reaction to a stressful event like being diagnosed with lymphoma and many people with lymphoma experience anxiety and worry after being diagnosed. While anxiety in this situation is normal, it is also uncomfortable and can make daily life difficult.

There are many effective ways to manage anxiety. Below we offer a few strategies to help, but this is not an exhaustive list. Different strategies work for different people. You may find other strategies that work better for you. Even the most effective coping and anxiety management strategies will not make anxiety disappear completely. Lymphoma is stressful and anxiety is normal in stressful situations. Here we offer three tips to help you manage anxiety and get through each day more easily:

  1. Take a Deep Breath

First, do not underestimate the benefits of taking a few deep breaths. Anxiety activates the body to prepare us to protect ourselves from a threat. This activation is helpful if we need to jump out of the way of an oncoming taxi. However, it is not helpful when we are trying to fall asleep or concentrate on what the oncologist is saying. Deep breathing helps calm the body which then reduces feelings of nervousness.

To take deep breaths, breathe in through your nose for two or three slow counts (imagine smelling a flower). Then, breathe out through your mouth for two or three slow counts (imagine blowing out candles). The breaths should be slow and controlled, but you should not feel like you are straining or holding your breath. You may find it helpful to say a calming word to yourself (“relax”) as you breathe out. One benefit of deep breathing is that you can do it anywhere and anytime. No one even knows you are doing it!

  1. Focus On One Day at a Time

A diagnosis of lymphoma can be overwhelming. When feeling overwhelmed, some people find it helpful to focus on one day at a time. What do you need to accomplish today? Are there decisions you need to make or tasks to complete now? If one day feels like too much to handle, focus on this morning or the next hour or the next minute. Every journey is a series of steps. Taking one step at a time can make the journey through lymphoma feel much more manageable.

  1. Get Support that Matches Your Needs

Support from others can be vital when adjusting to a lymphoma diagnosis. Different people need different kinds of support. What someone else experiences as supportive may not be helpful to you. You may even find that what you need from others changes over time. What kinds of support do you need from others? Is there someone in your life who is able to provide that support? Asking for help from others can be difficult, but you may find that you have people in your life that want to help, but are not sure what to do. Telling them what you need gives them clear instructions and ensures that the support they provide is helpful to you.

Dr. Trevino is an Assistant Professor of Psychology in Medicine at the Center for Research on End-of-Life Care in the Division of Geriatrics and Palliative Medicine at the Irving Sherwood Wright Center on Aging and NYPH Inpatient/Outpatient Palliative Care Consult Team.

The FDA Fast Track Designation: A Primer

Picture1By Peter Martin, M.D.

The Fast Track Designation was introduced by the FDA in 1997 under the FDA Modernization Act. It was designed to speed up the development and review of drugs that treat serious conditions and fill an unmet medical need. Like all expedited designations, the Fast Track was designed to get new treatments into the hands of patients in need.

The Fast Track designation must be requested by the treatment’s sponsor. To determine whether a treatment warrants a Fast Track designation the FDA decides whether a drug shows promise in treating a serious condition or fills an unmet medical need. Determining whether a drug treats a condition that is “serious” is largely a subjective matter, but cancers including lymphoma are universally agreed upon to match the criteria of serious conditions. The factors the FDA will consider include the drug’s impact on survival, day-to-day functioning, and if left untreated, whether a less severe condition will turn into a more serious condition. An unmet medical need provides a treatment option to patients where no such option previously existed.

If other treatment options are already available then the treatment applying for the Fast Track designation must show superior effectiveness, avoid any major side effects found in currently available therapies, improve upon the diagnosis to show an improved outcome, or address an emerging or anticipated public health need.

Treatments that meet these criteria are eligible for more support from the FDA for their application process. If the relevant criteria is met they are also eligible for the accelerated approval and priority review designations.

Previous Entries in the Primer Series

The FDA Approval Process
The FDA Breakthrough Therapy Designation
The FDA Accelerated Approval Designation
The FDA Priority Review Designation