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Non-Hodgkins Lymphoma News - Return to News Menu
Cancer therapy wipes out most of Goshen man's tumors
DAVID RUMBACH
Tribune Staff Writer
ELKHART -- Three months ago, William Hesse had a radioactive liquid infused into his bloodstream in the hope of turning back a recurrence of cancer.
It was a new approach to treatment that combines an antibody with a radioactive isotope to deliver a killing dose of radiation directly to malignant cells.
Around the time Hesse received his 10-ounce infusion, a national report suggested that the technique, called radioimmunotherapy, was being underused by oncologists, who have a financial incentive to prescribe chemotherapy instead.
Two radioimmunotherapy medicines currently available, sold under the brand names Bexxar and Zevalin, have been proven to work well against recurrence of the kind of cancer that threatens Hesse, the slow-growing form of non-Hodgkin lymphoma. As a further advantage, the whole course of treatment takes only two weeks, much less than treatment with chemotherapy.
Yet proponents of radioimmunotherapy claim that only one in 10 cancer patients likely to benefit from radioimmunotherapy is receiving it.
Hesse, a 75-year-old retired pastor from Goshen, opted for treatment with Bexxar at the recommendation of his oncologist, Dr. Jose Bufill.
Hesse was resolved to avoid another round of chemotherapy, which had caused kidney failure and other life-threatening complications for him 10 years earlier.
But he wanted relief from searing pain in his right arm and hip.
And he also wanted to extend his life and have more time with his wife, Mary, and their three daughters.
The moment of truth arrived Friday, in Bufill's office in Elkhart, 13 weeks after his unusual treatment.
A mixed result
A 10-ounce dose of Bexxar, customized for Hesse at a lab in Ohio and trucked to Memorial Hospital in a heavy tungsten container, was given to Hesse on May 25 treatment. Within two weeks, Hesse said the pain in his hip had disappeared.
But then the medicine's side effects hit, and Hesse entered a six-week period of dangerously reduced immune function and extreme "listlessness'' before he bounced back and began to feel like his old self.
"I'm anticipating I will be completely clean,'' he said before last Friday's meeting with Bufill.
The outcome was good, but not quite that good.
Bufill said a sophisticated, full-body scanning technique performed at Goshen Hospital, called PET/CT, showed that tumors had been suppressed in all but one of the spots detected in a pre-treatment scan.
Tumor activity had been detected in a lymph node on the right side of his neck, in his abdominal cavity, in the bone in his right upper arm and in the left side of his pelvis. All appeared to be gone.
"You've had a good response,'' Bufill said.
The scan did, however, detect increased metabolic activity -- a tell-tale sign of cancer -- in Hesse's right hip, he said. The radiologist who read Hesse's scan held out hope that this increased activity was due to healing of previous damage and not to the previously seen tumor.
A second post-treatment PET/CT scan will be taken in three months to determine if a tumor actually has survived in his right hip and whether conventional radiation treatment, delivered in an external beam, would be helpful.
"My hip does not hurt,'' Hesse said with characteristic optimism. "So I'm going to think of this as 'healing bone.' "
Assessing treatment
To determine how much a person has benefited from a cancer treatment, radiologists compare scans taken before and after the procedure, Bufill said.
There are four basic possibilities for the outcomes, the worst outcome is that the treatment had no effect and failed to slow the growth of tumors.
A minimally positive outcome is a treatment that stops progression of cancer, but does not reverse it all. A better result is a partial remission, defined as a shrinkage of tumors of 50 percent or more.
The best outcome, of course, is complete remission, although that result may be misleading to patients. It doesn't really mean that the cancer is completely wiped out and the person is cured, only that tumors are too small to be detected by the scanning technology.
It's not unusual for treatments to put slow-growing non-Hodgkin lymphoma into complete remission. But it almost always comes back, Bufill said.
"When you try to tell people that, they wonder 'So you're telling me it's not there but it could come back?' '' he said in an interview. "It's confusing for them.''
While's it's impossible to cure, slow-growing non-Hodgkin lymphoma grows very slowly and takes a long time to start causing illness, Bufill said.
"The survival for slow-growing lymphoma is often measured in years,'' he said.
Comparing side effects
Proponents of radioimmunotherapy over conventional chemotherapy point out that it is given in one infusion, which is administered within two weeks of a small test dose. A course of chemotherapy, by contrast, typically requires six infusions over four months or more.
The approach is also touted as a "guided'' therapy. The antibodies in Bexxar, armed with radiation, latch on to a protein found on the surface of 90 percent of malignant lymph cells.
"In that way, it's like a smart bomb,'' Bufill said.
But that doesn't mean the therapy is without side effects, as Hesse can attest. The antibodies in Bexxar also attack and kill many normal white blood cells creating a shortage of immune cells, called neutropenia, in about two-thirds of patients, according to GlaxoSmithKline, the marker of Bexxar.
Hesse became uncharacteristically apathetic and lost interest in eating, reading the Bible and other formerly pleasurable activities. The retired Missionary Church pastor even lost his normal "drive'' to pray.
"That bothered me,'' he said. "I did pray, but it was not like before.
"I'm a great one for planning ahead, an optimist, but it just wasn't there,'' he continued. "I got used to this, though, and lived with it.''
Mary Hesse said she knew her husband had recovered when she saw him building a birdhouse and joking about the chimney he was adding to the roof.
Bufill monitored Hesse carefully during this period because he also has diabetes and heart disease, along with cancer. His white blood cell counts eventually rebounded, as did his spirits.
Hesse said that his ordeal going through chemotherapy 10 years ago was worse than the aftermath of Bexxar. With chemo, he became sick, bottomed out and rebounded six times over the course of 18 weeks. Bexxar induced one long "bottom'' lasting six weeks.
"I think when you total both of them out, I believe I would opt for Bexxar,'' he said.
Staff writer David Rumbach:
drumbach@sbtinfo.com
(574) 235-6358
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