Lucy’s Story: Immunotherapy Trial Gives Lymphoma Patient New Hope

July 19, 2018 | by Dory Benford

Lucys Story | City of Hope Lymphoma patient Chin Yin Fan, who goes by the name Lucy
City of Hope is honored to be ranked among the nation’s best cancer centers for the twelfth consecutive year by U.S. News & World Report. It’s a powerful validation of our pledge to compassionate care. It’s also a reminder that the quest for a cure requires big, bold thinking – the kind of thinking that inspired the Toni Stephenson Lymphoma Center, which is developing revolutionary new treatments to help patients like Lucy.
 
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By the time Chin Yin Fan (Lucy) came to City of Hope, she had already been through quite an ordeal.
Years prior, she began experiencing labored breathing due to fluid in her lungs, an uncommonly fast heartbeat and trouble walking. To add to her frustration, one of her doctors missed an important appointment with her and another left her waiting for almost two weeks for test results while on vacation.
After the false starts and complications, Fan was eventually diagnosed with lymphoma and underwent chemotherapy to treat the disease. At first, her results were promising and she went into remission. Then, two years later, her cancer returned.
Distraught, Fan’s husband began to research potential treatment centers, and the couple decided to come to City of Hope, where Fan found herself under the care of hematologic oncologist Elizabeth Budde, M.D., Ph.D.

A New Option

Fan expected to begin chemotherapy again to treat her lymphoma, but Budde had another idea. She had recently helped launch an immunotherapy clinical trial at City of Hope, and was recruiting participants with Fan’s particular diagnosis.
“I knew she would be a good candidate because she had done chemotherapy before and didn't want to do it again," Budde said. "She really didn't want to lose her hair, so she was open to it."
Fan was also hesitant to start chemo again because in the past, it had negatively affected her moods and her outlook.
"With chemo, my side effects were terrible. I used to like to watch TV and read the newspaper, but after chemo, all I could do was sleep. It made me angry. I was angry all the time," Fan said.
Budde was also happy about the prospect of having a Chinese woman on her trial.
Being Chinese herself, Budde understands all too well the importance of minority participation in scientific studies, and the dangers of underserved communities being left out.

Critical Trials

Many members of minority communities are often hesitant to participate in clinical trials, but with each new patient added to a trial, physicians and researchers gain important knowledge about the disease they’re treating and how patients will accept that treatment. To make the medications being tested suitable for all people from all backgrounds, a diverse pool of patients is crucial.
"A lot of people, when they hear about clinical trials, they think that the treatments offered are very experimental and doctors are just testing it without knowing it much,” explained Budde. “That's actually not true. For a drug to enter clinical trial, there has already been a tremendous amount of work to understand the mechanism of action, efficacy and toxicities. So, every single therapeutic clinical trial is building on cumulative evidence from preclinical studies.”
Budde-Elizabeth Elizabeth Budde, Ph.D., M.D.
A clinical trial, said Budde, isn’t a shot in the dark.
“There's reason to believe that this drug will work and has reasonable side effects,” she said. “If it's too toxic, even at the preclinical stage, it would have been discontinued. Every single FDA approved drug used in the clinic was once in clinical trial at some point.”
This particular study — a phase 1/1b dose-escalation study — uses targeted immunotherapy to treat certain types of non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL).
"This is a multicenter, international clinical trial. City of Hope joined in early 2016, and Lucy was our second patient,” explained Budde.
City of Hope excels in the area of clinical trials because of the close collaboration between our scientists and physicians. Cancer patients have no time to waste when seeking lifesaving treatments, and at City of Hope, they can receive those treatments faster and earlier. The joint efforts across the organization move exciting new therapeutics from bench to bedside quickly, allowing patients to receive compassionate care without delay.
Lucy's treatment took place within City of Hope's Toni Stephenson Lymphoma Center, which advances patient-centered science and speeds discoveries to people who need cures now. Supported by a generous gift from the Stephenson Family, the center brings together renowned researchers, state-of-the-art facilities, novel studies and clinical trials under a central organization that facilitates scientific discovery. These lifesaving advances result in more powerful therapies and cures for people battling all forms of lymphoma. Each year, more than 250 patients with lymphoma are enrolled in clinical trials at City of Hope. 

Shocking Results

The plan was for Fan to have eight cycles of the treatment, coming in for one session every three weeks.
"When patients are receiving this kind of immunotherapy, they come in for an intravenous infusion of the antibody drug. Afterward, they are observed for a few hours to see if there is any adverse reaction. That’s really it,” Budde said.
Initially, Budde was shocked by Fan’s results.
"Lucy's case was very interesting," said Budde. "There was a lot of fluid around her left lung before the treatment, and that fluid had a lot of lymphoma cells. It is called malignant fluid. When she got the immunotherapy treatment, the fluid actually increased at first and her breathing got worse, so we thought the treatment wasn't working. We considered switching to chemotherapy, but then working with together Dr. Joo Song, my wonderful pathology partner, we tested the fluid and found a ton of T-cells — her immune cells.
“It was really amazing,” Budde continued. “I was shocked, because I thought her cancer was progressing. We didn't have enough experience at the time to know that more fluid doesn't necessarily mean the treatment isn't working. This showed us that something was going on, and her immune system was activated or ticked off at the lymphoma cells. So, Lucy got a little worse at the beginning, but then, she got better."

Sidelining Side Effects

And this time around, Fan only experienced minimal side effects during her treatments.
"Lucy had some low-grade fevers," said Budde. "Some people describe their reaction to this as being like a really bad cold. This is a targeted and specific therapy, by redirecting the T cells to the tumor cells with the target. So, there are very minimal or no bystander side effects like significant nausea, vomiting or hair loss."
Unlike the chemotherapy that Fan despised, this immunotherapy didn't dampen her spirits one bit.
"The treatment was really easy. It was no big deal. They just inject the medicine, and that's it. The process was perfect," said Fan.
Fan was also able to take advantage of City of Hope’s multidisciplinary approach to care. While undergoing immunotherapy to treat her cancer, she also received cardiovascular care in the same place, eliminating the need to see multiple specialists at different locations.
Over time, Fan’s results steadily continued to improve.
"Lucy actually entered complete remission after five cycles — the first City of Hope patient to do so. When I saw her for cycles six and seven, she just looked so good like a normal healthy person.” Budde marveled.
“She came in with her makeup done and nice clothes on. She told me that she has many, many beautiful clothes she likes to wear. And after her last cycle, she invited everyone to dim sum."

‘It’s Really Unbelievable’

For Fan, her time at City of Hope restored her faith in the medical community. She is healthy, feels great and couldn't be happier that she decided to go on the trial.
"I think this new medicine is really, really good. It rescued me. It's really unbelievable," Fan exclaimed.
"City of Hope is a very good hospital. Everyone was very, very nice — so happy. Everyone treated me like family. I'm so glad I came there. I'm so glad I found you. I feel very lucky."
Budde is thrilled with Fan’s response to the immunotherapy and encouraged by the other results she sees coming out of the study.
"We are very pleased," she said. "Moving forward, we hope to see the drug going down the path to get FDA approval, and I think we will get there. It’s looking really good and we are proud to be part of the process.”
 
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