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Kerryanne is a 77-year-old woman from Saskatchewan, Canada, who’d been diagnosed with stage IIA Hodgkin’s Lymphoma. Unfortunately, she had just failed two regimes of standard chemotherapy.
As a senior on disability with rheumatoid arthritis, Kerryanne had limited financial resources. She was dependent on the treatments provided to her by her public medical system oncologist.
Because she’d failed two previous attempts at controlling her disease, her oncologist told her they’d run out of treatment options: instead, they could offer her palliative care with a chemotherapeutic drug called vincristine. (Not only was this drug unlikely to benefit her condition, it also had many negative side effects.)
Kerryanne was told it was time for her to enter palliative care and get her affairs in order. But she wasn’t ready to accept this – so she reached out to CTOAM.
1. Personalized Records Review
First, we requested access to Kerryanne’s medical files and performed a complete review of them.
Confusion regarding diagnosis: Interestingly, we found there was considerable confusion about the diagnosis of Hodgkin’s lymphoma by her treatment team and tumour group. This was due to the lack of a specific type of cells known as Reed Sternberg cells, which characterizes Hodgkin’s Lymphoma. Therefore, her public health care team had sought a second opinion from a well known lymphoma pathologist.
Reason for misdiagnosis:This prominent lymphoma pathologist had concluded that, while Kerryanne had a malignant lymphoma consistent with Hodgkin’s lymphoma, she also had some features of another rare subtype of lymphoma called the lymphocyte-rich subtype. However, due to the lack of a typical nodular pattern of that subtype, the pathologist listed this case as classical Hodgkin’s lymphoma subtype.
The diagnosis of classical Hodgkin’s lymphoma seemed inappropriate to us. It was most likely based on the treatment options available in the province for this unique case.
We conducted a peer review study of Hodgkin’s lymphomas with lymphocyte-rich features and found out that this subtype had universal expression of a specific cell surface protein called CD20.
We further identified new clinical trial data that showed that when patients with lymphocyte-predominant Hodgkin’s lymphoma were treated with a common non-chemotherapy drug that targets CD20 (rituximab), the patients had a 100% response rate to the drug.
In this trial, all of the patients were still alive 5 years after treatment. In addition, since rituximab is a monoclonal antibody that only targets cancer cells with CD20, there were no grade 3 or 4 adverse effects.
Next, CTOAM’s specialists researched the Saskatchewan Cancer Agency’s treatment guidelines for Hodgkin’s lymphoma. We identified provisions in the guidelines to treat patients such as Kerryanne with rituximab (with or without chemotherapy/radiation).
With our knowledge that rituximab was also used to treat rheumatoid arthritis, we had Kerryanne contact a local Rheumatologist, and after sharing our research with him, he prescribed rituximab for Kerryanne, and the drug was covered by her public medical system due to her rheumatoid arthritis.
6. Patient Outcome
Rituximab is working very well for Kerryanne more than two years after starting it. The drug is also known to:
Since it’s a non-chemotherapy targeted drug, Rituximab has fewer and less severe side effects than standard treatment.
Outsmarting the Public Health System
This drug was approved and covered for a secondary condition that Kerryanne had: rheumatoid arthritis. Therefore, she was able to get the treatment she needed with much less stress and financial strain.
As you can see, CTOAM’s advanced diagnostics, records review, and consultations can result in significant benefits to a patient’s outcome. Having access to a team of precision oncology specialists, doctors, and patient advocates can make all the difference in the outcome of your disease.
If you or a loved one has cancer, contact us today so we can do a brief review of your medical records. CTOAM’s cancer research and patient advocacy experts will ensure that you have access to the most advanced tests and treatments available for your unique form of cancer – as close to home as possible.
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