What Promising Treatments Are Available for Diffuse Large B-Cell Lymphoma Patients?

What Promising Treatments Are Available for Diffuse Large B-Cell Lymphoma Patients? from Patient Empowerment Network on Vimeo.

What promising diffuse large B-cell lymphoma (DLBCL) treatments are available for patients? Expert Dr. Nirav Shah from Medical College of Wisconsin shares an update on emerging research and patient types who may benefit from potential treatment approvals.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“…understand their stage of disease and review the treatment options available for that stage and subtype of diffuse large B-cell lymphoma to best optimize the regimen to each individual patient.”

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Transcript:

Lisa Hatfield:

Dr. Shah, can you speak to some promising treatments that are available now for DLBCL patients? 

Dr. Nirav N. Shah:

Yeah, so while we consider DLBCL to be one disease, there is a lot of heterogeneity in it, and so there are sort of subtypes of DLBCL that we approach differently. And so the most well-known standard of care for DLBCL is a chemotherapy regimen called R-CHOP. It’s a five-drug regimen, it’s given once every three weeks for up to six cycles, again, depending on the stage, the presentation that the patient is in.

However, the goal has always been to do better than R-CHOP and there is an exciting new regimen called pola-R-CHP which gives you a drug called polatuzumab (Polivy) in lieu of an older drug called vincristine (Vincasar PFS), which is part of the R-CHOP regimen, and that regimen was tested head-to-head against R-CHOP chemotherapy and did have a slight improvement about a benefit of 5 percent to 6 percent in terms of its ability to induce a long-term remission, and again, that number may sound small, but every patient matters, and so that regimen, some of us have started adapting that, although I will note that that regimen is currently not FDA-approved, and so its accessibility and availability may be limited, although I’m optimistic that this regimen will be approved and become an option for the frontline for patients to come.

There are some types of diffuse large B-cell lymphoma that are a little bit more aggressive, we call some of these double-hit lymphomas, so a term that you may hear if you’re diagnosed and it’s something a doctor may talk about, and so for those patients, we often use a higher intensive regimen, the regimen that we use at our institution is a regimen called dose-adjusted EPOCH and so you can see here that it’s a little bit complicated, there are caveats here, there’s different treatment options available, and the number of treatments we give is partially based on how you present and the stage that you initially show up with. And so I think that it’s important to have a conversation with your physician. And so my activation tip for patients is to understand their stage of disease and review the treatment options available for that stage and subtype of diffuse large B-cell lymphoma to best optimize the regimen to each individual patient. 


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What Is the Ann Arbor Staging System for Diffuse Large B-Cell Lymphoma?

What Is the Ann Arbor Staging System for Diffuse Large B-Cell Lymphoma? from Patient Empowerment Network on Vimeo.

What is the diffuse large B-cell lymphoma (DLBCL) system called Ann Arbor staging? Expert Dr. Nirav Shah from the Medical College of Wisconsin explains how DLBCL differs from other blood cancers and symptoms that characterize each DLBCL stage.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“…make sure they really understand their scan and what stage they are, and how that impacts the treatment that the doctor is offering.”

See More from [ACT]IVATED DLBCL

Download Resource Guide

Download Resource Guide en español

Related Resources:

How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient

How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient?

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How Are Bispecific Antibodies Being Used in Diffuse Large B-Cell Lymphoma Treatment?

How Are Bispecific Antibodies Being Used in Diffuse Large B-Cell Lymphoma Treatment?


Transcript:

Lisa Hatfield:

I know as a blood cancer patient, my number one question is, what stage do I have and what is my prognosis? So can you explain the staging system a little bit, I think it’s called the Ann Arbor staging system for DLBCL and then maybe prognoses that you may or may not feel comfortable giving to each patient.

Dr. Nirav N. Shah:

Yeah, so lymphoma is a little bit different, because it’s a blood cancer that involves lymph nodes, and so how we stage it is based on the location and the number of lymph nodes involved, if, for example, you had one lymph node in your neck, and that’s all you had, we would consider you to have stage I diffuse large B-cell lymphoma. If you had more than one lymph node, but on the same half of the body, thinking of your diaphragm as sort of a midpoint, we would then consider you to have stage II disease. If you have lymph nodes on both halves of the body, we would then consider you to have stage III disease, and if you have organ involvement, so bone marrow involvement, liver involvement, kidney involvement or lung involvement, we consider those patients to be stage IV.

Now, to a certain degree, the higher the stage, the worse the prognosis, but as I stated earlier, even patients with stage IV lymphoma can be cured, and that’s different than other cancers, right? When we think about stage IV colon or stage IV breast, many of those patients, we actually tell them that they’re in a non-curative setting, and so while the prognosis for stage III and IV is a little bit worse than those patients who have stage I to II disease, I do try to focus on that we do treat with curative intent, and we do alter our treatment regimens according to the stage of disease that they present with, and so my activation tip for patients in this setting is to make sure they really understand their scan and what stage they are, and how that impacts the treatment that the doctor is offering. 


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How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient?

How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient? from Patient Empowerment Network on Vimeo.

How do diffuse large B-cell lymphoma (DLBCL) experts explain this cancer to newly diagnosed patients? Expert Dr. Nirav Shah shares his perspective on how he leads patients through their diagnosis and treatment phases and key points that he shares to educate his patients.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“…learn as much as they can about this diagnosis and take notes, because I know that often patients in that first visit don’t really register everything. Just because they’re feeling overwhelmed.”

See More from [ACT]IVATED DLBCL

Download Resource Guide

Download Resource Guide en español

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What Is the Ann Arbor Staging System for Diffuse Large B-Cell Lymphoma

What Is the Ann Arbor Staging System for Diffuse Large B-Cell Lymphoma

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How Can Your Diffuse Large B-Cell Lymphoma Care Team Help in Treatment Decisions

Why Is Clinical Trial Participation Vital for Diffuse Large B-Cell Lymphoma Patients

Why Is Clinical Trial Participation Vital for Diffuse Large B-Cell Lymphoma Patients


Transcript:

Lisa Hatfield: 

Okay. So, Dr. Shah, you have a patient that comes into your office newly diagnosed with DLBCL, maybe from their…or they’ve heard it from their primary care provider, they understand, they looked it up on the Internet, diffuse large B-cell lymphoma, they see the lymphoma, I would anyway, I’d see lymphoma, and I know it’s cancer. What’s included in your initial evaluation, how do you explain in basic terms to a newly diagnosed patient what DLBCL is? 

Dr. Nirav N. Shah: 

Yeah, great question, Lisa. I think that any time somebody gets that diagnosis with a cancer label on it, it’s incredibly overwhelming, and so what I try to do when I see my new patients is first simply just learn about them. How did this come about, what symptoms led to this diagnosis? Learn about their past medical history, which impacts how I might treat them and what options I’m going to give them, and sort of learn about who they are a little bit, learn about their family, what they do for a living, because I think those are important values to know about your patients, when trying to make a treatment decision.

What I try to explain to these patients is that DLBCL, yes, it is a cancer. Yes, it is, unfortunately, an aggressive cancer, one that can be very rapidly growing, but unlike a lot of cancers, it is a curable type of cancer, and I really try to highlight that like all cancers, unfortunately, not every single patient is cured with diffuse large B-cell lymphoma, but initially, I think there’s reason to have optimism and hope because the goal is, for me, when I meet a new DLBCL patient to provide a curative intent treatment approach for them.

As a part of that initial evaluation, we need to know more about where their disease is and in lymphoma. We often use a PET-CT, which is a special type of scan that sort of lights up areas that can be involved with lymphoma. In some cases, we do a bone marrow biopsy, although that is less indicated now because of how good the PET scans are, and then we talk about other testing, a lot of the chemotherapies can cause problems to your heart, so we often do an ultrasound of your heart to make sure it’s healthy enough to be able to tolerate some of the regimens that we consider for this disease, and then we talk about access in terms of how are we going to get the chemotherapy into the patient, and whether or not they would need a device like a port. But the main focus of the conversation is explaining the disease, teaching about the disease and focusing on that unlike other cancers, even stage III or IV diffuse large B-cell lymphoma is a curable entity, and the key is moving promptly getting the workup done in an efficient but complete manner and then initiating a treatment plan. 

Lisa Hatfield:

Right, thank you. And if you had one tip for patients when they first come in, what would you tell this patient that’s coming to see you in? 

Dr. Nirav N. Shah:

Yeah. I think my activation tip would be to learn as much as they can about this diagnosis and take notes, because I know that often patients in that first visit don’t really register everything. Just because they’re feeling overwhelmed.


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[ACT]IVATED DLBCL Resource Guide

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