Beating lymphoma into remission with a one-two punch
Grounded by disease, a pilot flies again with the help of an immunotherapy drug combo
When Dan Minton noticed a recurring swelling in his neck, he headed for the doctor’s office. A biopsy revealed some unexpected news.
“I was devastated, to say the least, because I’ve always been very healthy and active,” says Minton, 57, who lives in North Carolina. “Neither side of my family had a history of cancer, so hearing the word ‘lymphoma’ came as a complete shock.”
Lymphoma is a cancer of the lymphatic system, which is a part of the immune system. Divided into two types, lymphomas are either Hodgkin’s or non-Hodgkin’s, with the latter accounting for more than 90% of cases.
Lymphomas begin when immune system cells called lymphocytes — white blood cells that help the body fight infection — begin multiplying uncontrollably.
Left untreated, these cells can invade other parts of the body, including lymph nodes, and complicate a patient’s prognosis.
Part of the shock Minton felt when hearing his diagnosis was not knowing the cause of his disease.
“Our body’s white blood cells mutate to recognize foreign invaders, and when this process goes wrong, the cells become malignant,” says Nathan Fowler, M.D., associate professor in Lymphoma and Myeloma. “Unlike other diseases where we can point to smoking or sun exposure, we know of few risk factors that lead to lymphoma’s development.”
After conducting his own research, Minton, a father of four, decided to place his health in the hands of the experts and flew to Houston in late 2012. At MD Anderson, his diagnosis of a subtype of non-Hodgkin's lymphoma known as stage III follicular lymphoma was confirmed. Doctors told Minton about a promising clinical trial involving two existing drugs that hadn’t been used in combination before.
The two drugs, lenalidomide and rituximab, represent a growing shift away from using chemo for treating lymphoma, says Fowler, who is Minton’s oncologist. Together the drugs work by stimulating the body’s immune system to recognize cancer cells and destroy them, removing the need for chemo and its side effects.
The combination is proving especially beneficial in follicular lymphoma, a disease known for high relapse rates. Led at MD Anderson, the initial pilot study of the two drugs in 2008 enrolled 30 patients. Researchers were astonished when they found 100% response rates in those with follicular lymphoma.
“Although the number of patients who responded was small, seven total, we became very interested in this combination and immediately expanded the trial to 110 patients,” Fowler says. “As we hoped, the results of the larger group mirrored what we saw earlier with an overall response rate of 98 percent.”
Since beginning treatments with the combination, Minton noticed the swelling in his neck reduced dramatically in a matter of weeks. Five months later, in the spring of 2013, he was in complete remission.
“My response to treatment has been great, without any relapses, and I currently come to MD Anderson every two months for maintenance therapy,” he says. “I’m looking forward to completing the trial early next year and I’m very hopeful about what the future holds.”
Minton’s case is a snapshot of the rapid progress science is delivering. Others notably point to the development of ibrutinib, for which MD Anderson led the first in-human trials. That drug has revolutionized care for two different types of disease, mantle cell lymphoma and chronic lymphocytic leukemia.
Before ibrutinib, the median survival of mantle cell lymphoma was three years, but some patients on the drug have remained in remission up to five years, Fowler says.
“It’s such an exciting time for researchers and patients in many subtypes of lymphoma,” he says. “For the first time in decades, these breakthroughs in our understanding of the disease are translating to clinical advances and literally changing survival patterns.”
For Minton, the advances are somewhat simpler. Progress allows him to focus on the things that matter most, such as family. This includes two grandchildren, managing a real estate business and his favorite hobby, flying.