Collaboration Helps Make Clinical Trials Possible
While the UW Carbone Cancer Center is housed in Madison, it brings world-class cancer care to nearly every corner of the state through the Wisconsin Oncology Network (WON), a collaboration of 19 member clinics across the state and region.
And like every good partnership, this one is not a one-way street. The Carbone Cancer Center relies on the patients and providers at WON sites to participate in Carbone Cancer Center-led clinical research that could not be completed in Madison alone.
Take UW Carbone Cancer Center hematologist Dr. Julie Chang’s mantle cell lymphoma (MCL) clinical trial for example. MCL is a rare type of non-Hodgkin’s lymphoma. It is often a challenge to find enough patients in which to test a new treatment.
Chang proposed using the standard of care drugs for MCL, but boosting it. The treatment would use a higher dose of the standard therapy plus another FDA-approved MCL drug. This altered therapy might lengthen patients’ remission times. Chang needed a clinical trial with enough patients to determine if the modified therapy was better for most patients, so she opened the trial through WON.
“The study had 30 patients, which doesn’t seem like a lot, but because the disease is rare it would have taken too long to accrue patients at UW alone,” Chang said. “Yet between the UW and WON, we were able to accrue to the study and get meaningful data.”
Despite its name, MCL behaves differently than many lymphomas. Consequently, it needs to be treated differently. The first line of therapy, known as R-CHOP, can cure some types of lymphoma, but it is not curative for MCL. After treatment, MCL patients see an average first remission of 18 months.
“Your first remission is always your best, and its length can be extremely telling for how the disease is going to behave,” Chang said. “Each successive treatment will give shorter and shorter remissions. The goal of this particular trial was to give a little bit more intensive first-line therapy and hopefully help these people stay in remission a little bit longer.”
In this study, Chang and colleagues gave MCL patients the same combination of chemotherapy drugs as in R-CHOP but in higher doses. They added another drug, bortezomib (Velcade), that has been FDA-approved for treatment of MCL. After treatment, they gave patients five years of maintenance therapy with rituximab (Rituxan). The study started in 2005 and closed to accrual in 2008.
“When we initially published results of the trial in 2011, 63 percent of patients were still in remission three years after treatment,” Chang said. “We followed patients on the trial until 2016, and now eight years after the last person accrued on the trial, 50 percent of patients are still in remission, indicating that there was a remarkably small margin of people who relapsed after three years. In fact, everyone who was in remission after five years was still in remission after eight.
Patients at Aspirus Hospital in Wausau, St. Vincent’s Oncology in Green Bay, Gundersen Lutheran in La Crosse and UW Carbone in Madison participated. The results were presented at the annual meeting of the American Society of Hematology conference in San Diego earlier in December 2016.
Based on the results first published in 2011, the WON treatment protocol was developed for use by a larger oncology network, the Eastern Cooperative Oncology Group (ECOG) (ECOG protocol E1405). That study is currently being analyzed, and the results are expected to be reported in 2017. Chang said if the ECOG trial’s results agree with those of the WON trial, then the combined results will be a major factor in deciding if this intermediate-intensity chemotherapy moves forward for the treatment of MCL.
Date Published: 04/05/2017