In previous posts I wrote about matching treatment to the patient’s tumour. Currently, we choose treatments primarily based on what the lymphoma looks like down the microscope.

At this time, we treat all patients who have diffuse large B-cell lymphoma, the most common form of lymphoma, with one chemotherapy recipe called R-CHOP. This works quite well, curing about 60 percent of patients. But if the treatment fails the disease becomes very difficult to overcome.

To improve outcomes and make a difference for patients, research needs to be translated into targeted therapies and tests to choose the best treatment for our patients. For these reasons, I am particularly proud of the test we developed to identify two types of diffuse large B-cell lymphoma. I believe that in the near future this test will be used in the clinic. This will allow us to move away from a “one size fits all” approach by selecting therapies that work better in one or other type of this lymphoma. 

Right now our research into diffuse large B-cell lymphoma is strongly focused on why our chemotherapy fails to cure some patients. We have gained clues from looking at mutations that are seen in the cancers of patients that aren’t cured when they are treated with R-CHOP.

Our next move is building on the fact that a person’s cancer is not made of identical cells, and that by being made of different (but related) cells cancers can “evolve” much like the finches that Darwin saw on the Galapagos Islands. The size and shape of the birds’ beaks had adapted to, and been selected by, the environment they lived in—“survival of the fittest”.

Using this way of thinking, we are looking at cancers before and after chemotherapy to identify the “fittest” cancer cells—the one’s that resist our treatments. This will help us work out what mutations cause our therapies to fail and develop new strategies to cure these cancers.

It is a very exciting time to be researching lymphoma because we are starting to make sense of the biology of lymphomas and are identifying ways to kill lymphoma cells by exploiting vulnerabilities unique to these cells. In the next five to 10 years, I believe that we will see major gains in patient outcomes by translating this knowledge into ways to improve how well our therapies work while minimizing side effects.

David

Clinician-scientist, BC Cancer Agency