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Aimee Martin (Host):  Welcome to the Oncology Sound Byte, a podcast produced by the Seattle Cancer Care Alliance, designed to offer byte sized audible oncology education from one of the top cancer treatment centers in the nation. Medical professionals can tune in to learn from our nationally renowned team of experts representing Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Children’s. We hope you’ll listen and learn while we share disease-specific advancements with the collective goal of improving cancer care and patient outcomes both regionally and beyond.

I’m your host, Aimee Martina Senior Physician Liaison at the Seattle Cancer Care Alliance. During this episode, we will focus on diffuse large B cell lymphoma or DLBCL as we will commonly refer to it during the show, and the latest treatment options available. With that in mind, I’d like to introduce our subject matter expert joining us today, Dr. Ryan Lynch who serves as an Attending Physician at SCCA. Welcome to the show Dr. Lynch.

Ryan C. Lynch, MD (Guest):  Thank you so much for having me.

Host:  Great to have you and I wanted to just start out by asking you to explain your role a little bit more at SCCA and your professional background.

Dr. Lynch:  Yeah great, thank you. So, I am a lymphoma specialist at Seattle Cancer Care Alliance and so what that means is that I only see lymphoma patients at SCCA and so one advantage that I have is I get to focus very specifically on one subtype of cancer. And another part of – another role that I have is as a clinical researcher. And so when I’m not in clinic, I am working on development of clinical trials, retrospective research or essentially looking back at how we treat patients and see if we can learn something from how we’ve treated patients in the past and how that may affect how we treat patients in the future. And we try to integrate some of the newer targeted agents into the treatments of diffuse large B cell lymphoma and other subtypes of lymphoma as well.

Host:  Great. And it’s so great that you have that area of expertise. So, I’m curious, what current clinical trials are currently available in this space of DLBCL?

Dr. Lynch:  Yeah so, DLBCL is the most common subtype of lymphoma and it effects primarily patients between age 60 and 80 but it can affect patients really at any age. And one good thing about diffuse large B cell lymphoma is that it is a curable cancer even when patients have stage IV disease. And the way that this is cured is through combination chemotherapy, so not just giving on drug but giving multiple drugs at the same time. And so, historically, what this meant – what chemotherapy was just various types of for lack of a better term, poisons, that affect every cell in the body. But just so happen to preferentially affect cells in the body that grow very quickly. So, that’s one of the reasons for example patients lose hair when they are on chemotherapy is that hair grows relatively quickly compared to other cells in the body and can be affected by chemo.

But in subsequent decades, we realized that the addition of targeted agents, modern agents, can actually improve the cure rates. But diffuse large B cell lymphoma has been stuck for about 15 or more years or so and there have been a lot of clinical trials that have tried to improve the outcomes in newly diagnosed diffuse large B cell lymphoma and unfortunately, there hasn’t been any winners in that time. And so, we do have several clinical trials that are open here including a couple that are actually home grown clinical trials. And when I say home grown, meaning they were conceived, designed, written and implemented at our center. So, not through – this isn’t something written by a pharmaceutical company, this is an idea that we take to companies that provide drugs and try to get small grants for funding. They are from the company or other places in order to do them. And so we have a couple studies open both for new diagnosed lymphomas as well as relapsed lymphomas. And these integrate really cool targeted agents into the treatment.

Host:  Dr. Lynch, I believe there’s also some new studies out specific to aggressive DLBCL. Can you elaborate on those?

Dr. Lynch:  Yeah, so we have a study that’s open or that’s about to open in fact. So, there’s some very high risk large B cell lymphomas and so there are some where you look at the different characteristics at diagnosis and historically these patients have not done very well with standard therapies. And so there’s a drug called polatuzumab vedotin which is a targeted drug against a protein that’s on the surface of the lymphoma cells and this drug acts in many ways like a trojan horse. So, this drug attaches only to the cells that have this target but, on this drug, is essentially a toxin and so that’s why I say it’s like a trojan horse. It seems benign and so the cell brings it into – inside of it and then the toxin gets released inside the cell. But this toxin doesn’t get released as much into noncancerous cells because it preferentially attacks these cells. And so, we proposed combining this with a combination chemotherapy regimen to try to improve the outcomes in these patients.

And then the other study that we have open is in the relapse setting and so historically, patients who have relapse diffuse large B cell lymphoma, some of these patients can be cured with additional chemotherapy and something called an autologous transplant. The autologous transplant is a treatment that allows for us to give higher doses of chemotherapy by saving the patient’s stem cells and infusing them back in later. But the study that we have open is a way to integrate one of these new targeted agents a drug called copanlisib with a combination chemotherapy regimen to try to improve the chances of success of treatment.

Host:  That’s incredible. It sounds really promising and exciting to hear about. I am curious just I feel like it’s important to just address the current circumstances that we’re in with Coronavirus and how that may have had any impact on your current practice and how you treat patients at this time?

Dr. Lynch:  Yeah, so that’s a really great question and we have had a lot of meetings well Zoom meetings with other members of our group, having these discussions. In fact, we just as a group, published an article between our lymphoma group, our multiple myeloma group and our leukemia group. We just published an article in the Journal of Clinical Oncology, Oncology Practice describing how we have modified our practice to treat heme-malignancies in this setting. But I think in short, for diffuse large B cell lymphoma, because this is a – it can be a very aggressive lymphoma, it can be cured with combination chemotherapy with very rare exceptions, we’re not seeing a big change in how we’re managing these types of patients because if they are able to – these types of patients aren’t usually able to delay their treatments. Meaning that, slower growing cancers can usually – maybe you can put that off for a couple of months until things get better but usually these aggressive lymphomas are so serious, these patients are seeking out attention and we are at a point where we are able to treat these patients effectively and we have not seen any compromise in how we are treating a newly diagnosed diffuse large B cell lymphoma thankfully at least here in Seattle.

Host:  Yes, very thankfully. It’s definitely a crazy time right now in the healthcare space. But I so appreciate you taking the time out of your busy schedule to share more information about this space and the treatment options available. Is there anything else that you would want to share before we wrap this up?

Dr. Lynch:  Yeah, so we have actually been able to integrate Telehealth into our practice more and more and historically, there were limitations in terms of insurance reimbursement for this practice and now because of the Coronavirus pandemic, a lot of these restrictions have gone away and we have been strongly encouraged and I can’t think of any provider that hasn’t gotten a set up to do Telehealth visits and so, in some respects for select patients, we’re making house calls again but this time through webcams and the internet and so I’ve had the opportunity to be invited into people’s homes so to speak and do consultations. Now certainly if somebody needs to physically be here for an infusion, I’m going to see that patient in clinic. But certain types of consultations, second opinions, long term follow ups, a lot of that can be done by Telehealth. And certainly we are trying to – we’re hoping that this will continue after this pandemic subsides and will hopefully provide an opportunity for patients to seek out the expertise that we offer, the disease specific expertise in not just in lymphomas but of course in other cancers as well.

Host:  Thank you so much for joining us today Dr. Lynch. And thanks to our listeners for tuning in to the Oncology Sound Byte.

Dr. Lynch:  Thanks for having me Aimee.

Host:  For more information about today’s topic and other relevant healthcare provider news from SCCA, please visit our provider blog page at www.seattlecca.org/provider-blog and subscribe to our e-newsletter for access to future episodes and clinical updates. You can also find the Oncology Sound Byte in your favorite podcast app plus if you like what you’re hearing, be sure to lease us a review. Until next time, thanks for listening and take good care.