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I saw an 84-year-old white female almost one and a half years ago. She presented with a mass in her mouth and a biopsy showed that it was mantle-cell non-Hodgkin lymphoma, or NHL.
Lymphomas can be Hodgkin or non-Hodgkin type; the latter is much more common. There are many different kinds of non-Hodgkin lymphoma. About 7 percent of people with NHLs have mantle-cell lymphoma. It most often appears in people older than 60. It usually involves the bone marrow, lymph nodes, spleen and gastrointestinal system (esophagus, stomach, intestines). Mantle-cell lymphoma is usually identified by a protein called the cyclin D1 protein.
The patients with mantle-cell NHL, or MCL, are treated initially with chemotherapy. Most patients initially respond well to chemotherapy. My patient was treated with chemotherapy and she responded very well, as expected. Her cancer went into complete remission.
I just did a PET/CT scan and her cancer is still in remission. This is one and half years after diagnosis.
Unfortunately, mantle-cell NHL is not curable, and it tends to recur after a few years. When that happens, the patients need another chemotherapy. Recently, the FDA approved a new drug — Ibrutinib (Imbruvica), a “breakthrough” drug for MCL that has been hailed as a successor to traditional chemotherapy in treating hematological cancer.
This study was published in the New England Journal of Medicine in June 2013. The study consisted of 111 patients with MCL who took the once-daily drug, 68 percent had their cancer shrink or disappear. Other drugs treating MCL have much lower response rates. Those who responded tended to respond for a median of one and a half years. This is very encouraging.
This is an oral drug and is taken as four pills a day. The most common adverse events experienced by clinical-trial participants include low blood counts, diarrhea, fatigue and body aches. Overall, it is well tolerated.
This drug in other studies has shown to be very effective in other cancers like CLL or chronic lymphocytic leukemia, and Waldenstrom’s macroglobulinemia. We will need to wait for approval in these cancers.
This drug works by a completely different mechanism of action. It is going to be very expensive and will cost more than $100,000 a year. It will revolutionize the way we treat MCL.
If my patient’s cancer ever recurs, she may be a good candidate for this new drug.
Dr. Sunil Gandhi is a hematologist and oncologist. He is the volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email email@example.com or call 352-746-0707.