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Refractory Cancer Completely Remited without Chemotherapy


 Lymphoma is a type of cancer which arises from a subset of white blood cells. A type of lymphoma is Diffuse large B cell lymphoma (DLBCL) which is generally treated with chemotherapy. One such patient, a 56 yr old gentleman, presented to the Department of Medical oncology and Hematoncology  at Artemis Hospital / Artemis cancer centre , Gurgaon a few months back. He had lost all hope and had previously been treated with three different types of chemotherapy as well as radiotherapy in the last 18 months. The patient had relapsed twice and showed no response at all to the third line of chemotherapy.

At Artemis, the diagnosis was reviewed and confirmed to be Activated B-cell type of Diffuse large B-cell lymphoma after a diagnostic as well as palliative tonsillectomy.  The treating team of oncologists led by Dr Prashant Mehta and Dr Prof. Rakesh Chopra adopted a novel way to treat this difficult and resistant tumor which otherwise had almost no chance of responding to conventional chemotherapy.

The tumor was sent for genetic analysis and it was found that  it harbored a specific genetic mutation in a cellular protein called CD79B. CD79B mutations have been reported in 8-16% of DLBCL samples, including 21% of Activated B-cell DLBCL samples.

This led the treating oncologists to use a specific targeted drug called Ibrutinib which has previously shown responses in tumors having this kind of genetic mutation. After 3 months of therapy with the drug which is taken orally in the form of capsules daily, a PET-CT scan showed that there was no sign of lymphoma in the patient, known as a complete remission in scientific language. This kind of response is rare in such refractory, aggressive lymphomas with chemotherapy alone.

The team believes targeted therapy is going to be the backbone of cancer treatment in future, and should always be kept under consideration when treating such complex tumors.

There are targeted agents available for several different cancers, for example Imatinib,Rituximab, Trastuzumab, erlotinib and cetuximab. These drugs have changed the treatment of cancer forever. We should know and understand that although chemotherapy is an important component of cancer treatment, it is not the only answer, it is important to explore and incorporate other strategies, like in this case, Ibrutinib. Another strategy is immunotherapy which arms the body's own self defense mechanism to kill tumor cells. We need to treat cancer with open eyes and should avoid getting tunnel-visioned . Genetic analysis can sometimes provide options which are safer to use and may provide disease control without significant adverse effects' ,said Dr Prashant Mehta, the treating oncologist from the dedicated Medical oncology/Hematoncology team at Artemis hospital.

Patients of lymphoma generally have swelling in the neck, groin and/or armpits along with fever, weight loss, loss of appetite and sweating at night as presenting symptoms. It is important to diagnose it early so as to improve the chances of cure. In India, many patients of lymphoma get a delayed diagnosis as it can mimic tuberculosis which is a common problem in India. Such symptoms should be taken seriously and a medical consultation should immediately be sought so as to improve outcome and prevent delay in diagnosis

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