This is a case study of a 25-year-old boy who was diagnosed with Hodgkin’s Lymphoma in 2012. Despite receiving standard chemotherapy and an autologous transplant, the patient’s disease was refractory and had a poor prognosis. The patient sought additional treatment options and was treated with the novel targeted therapy Brentuximab Vedotin, resulting in a complete remission and eventual cure.
Family Concerns:
The patient’s family was informed of the poor prognosis and the limited treatment options available. They were also informed of the potential risks and benefits of the novel therapy.
Investigation:
An initial Chest Xray showed a large mass in the mediastinum. A PET CT Scan was then done. This showed a 20 cm mediastinal mass with multiple regional lymph nodes. A biopsy gave the diagnosis of Hodgkins Lymphoma, the classical type.
Treatment Offered:
The patient then went on to receive the standard regimen of that time, ABVD for 12 cycles at 15 day intervals. Unfortunately, at the end of the chemotherapy, the follow up PET scan showed only a minimal response. He was then worked up for an Autologous transplant preceded by a high dose conditioning regimen.
3 cycles of second line chemotherapy with Gemcitabine and Cisplatin were given followed by high dose conditioning and an Autologous transplant. PET CT Scan performed 3 months post transplant showed active disease with no response to the intensive treatment given. At this point this patient was considered to have refractory disease. He along with his family was duly informed that he had a poor prognosis, there was no established regimen remaining that could potentially cure him. His death was expected.
This is when he visited me, seeking any option that could help him. I suggested a novel targeted therapy , called Brentuximab Vedotin, which is a drug that targets a particular molecule on the lymphoma cells. As it wasn’t a chemotherapy drug, and its mechanism of action was highly specific to the tumour, I expected it to give us a good result. I had participated in the clinical trials of this drug in Seattle in 2011, and had seen miraculous results in a number of patients with extensive disease. Almost all had gone into remission and there had been no relapses till date.
As the drug was not available in India, I had it imported from England. 6 cycles were then administered. The medicine was extremely well tolerated with zero side effects. It was given as a day care therapy , a 30 minute intravenous injection. Pet scan at the end of 6 cycles showed no active disease. We had full control of this aggressive malignancy in a patient who had been given no chance of survival.
To consolidate the response, the patient then underwent a fully matched Allogenic stem cell transplant, using his sister as a donor.
By 2014 beginning all treatment was completed. Regular PET CT Scans were performed for the next 5 years, all being normal. In 2018, I concluded that he was cured. In 2019, he was married. In 2022, he celebrated 8years of being cancer free.
He was one of the first patients in India to receive Brentuximab Vedotin and a prime example of the wonders of modern Oncology. Out of the box thinking saved his life.
Results:
The patient’s PET CT Scan at the end of the six cycles of Brentuximab Vedotin showed no active disease. Regular scans were performed for the next five years, all were normal. The patient was considered cured in 2018, and went on to marry in 2019 and celebrated 8 years of being cancer free in 2022. This case illustrates the effectiveness of targeted therapies in treating refractory Hodgkin’s Lymphoma.
