I still remember his words: “The good news is that I didn’t see any signs of cancer. No polyps or anything like that. But I’ve been doing this for over 20 years, and I don’t know what I’ve just seen. I took a couple of biopsies.”

I left the surgical center with some pictures and a lot of questions. 

It took doctors just 10 days to determine this 50-year-old man had both lymphoma and leukemia — on top of my already diagnosed multiple sclerosis (MS). 

These days, we sometimes hear how “broken” the American health care system is. But the truth is that you have scores of victories at Norton Healthcare every day. I know because I’m one of them. And I didn’t have to leave Kentucky to receive this superior care.

My story began in January 2017 when I entered Norton Brownsboro Hospital’s emergency department with “stroke-like” symptoms. Through testing and the expertise of your physicians, I was diagnosed with multiple sclerosis and have been a patient of Norton Neuroscience Institute neurologist Geeta A. Ganesh, M.D., MPH, ever since. 

The next two years were challenging as I worked to recover from that episode. Unbeknownst to us all, a more sinister condition was developing inside my body. And by early 2019, I was nearly incapacitated with gastrointestinal problems that I was convinced were rare symptoms of MS. Only through Dr. Ganesh’s advice and care was I put on a path to ultimate healing.

Dr. Evans, who is now with Norton Gastroenterology Consultants of Louisville, referred me to Terence Hadley, M.D., who has since retired as an oncologist from Norton Cancer Institute. He diagnosed me with small B-cell lymphoma and chronic lymphocytic leukemia. While both of these diagnoses are sadly quite common, my particular case was anything but that. Dr. Hadley informed us of the rarity of my case and that it was a presentation he had never encountered in his career. He was able to find four documented similar cases. Sadly, none of those four had survived. 

Only through his intelligence, compassion, curiosity, persistence and humility am I here today to share this remarkable story. My case was presented to the tumor board. The consensus was that demographically I was a candidate for the standard treatment. But Dr. Hadley thoroughly understood my prognosis. He did not believe I would survive the rigors of that treatment. Though my condition was “unstageable,” and a suitable course of treatment was not immediately apparent, he was determined to find the best path forward. My family and I had full faith in his ability, but the following six weeks were torturous. Mentally and psychologically, I was preparing to die. I am one of the most optimistic people you might encounter. I had even told Dr. Hadley that I would not enter treatment if the treatment itself would kill me.

At his retirement, Dr. Hadley referred me to Khuda D. Khan, M.D., a hematologist and medical oncologist with Norton Cancer Institute. Dr. Khan knew the complicated nature of my case, and it demanded his expertise and care. It was a seamless transition. I am proud to share with you that I am in remission today. 

So many patients seek the expertise of nationally renowned hospitals and centers of excellence, and rightfully so. But I have received superior care right here at Norton Healthcare and in the comfort of my hometown with my family, friends and loved ones by my side. At every juncture, I have been treated as a person with dignity and as an equal partner in discerning the best path. 

We often hear stories of miracles in this world, but I truly believe the care, the science and the doctors and staff that have provided me with such excellent care are miracles in and of themselves. My hope is that my story will stand as a testament to the world-class care that Norton Healthcare provides.

Before my retirement, I spent my career working in higher education and nonprofit fundraising. In that time, I learned that organizations that can most clearly and concisely tell the stories of how their mission is making a difference in this world are the most successful and effective. I am a firm believer in a principle that guided the late Ed Sabol, founder of NFL Films: “Tell me a fact, and I will learn … tell me a truth and I will believe, tell me a story and it will live in my heart forever.”

My hope is that my miraculous story will provide hope, knowledge, and awareness for other patients and for Norton Healthcare.Mike Goetz, who works in collegiate athletics, lives in Louisville.

The post Louisville man finds sophisticated and successful cancer care close to home appeared first on Norton Healthcare.

Our bodies don’t always fight off cancer naturally because the cancer cells actually masquerade as healthy cells, and the immune system lets them go on to grow and spread.

Treatments that adjust the immune system to fight cancer are known as immunotherapy. At Norton Cancer Institute, researchers and clinicians are trying new ways to make immunotherapy even more effective using chimeric antigen receptor (CAR) T cells to lift the mask that cancer cells hide behind.

CAR-T cell therapy is currently in use as a standard treatment at Norton Cancer Institute, following Food and Drug Administration (FDA) approval, to fight some forms of non-Hodgkin lymphoma that haven’t responded to other treatments or have recurred. Recent FDA approval for CAR-T cell therapy includes mantle cell lymphoma, which is a particularly fast-growing blood cancer that has been resistant to conventional treatments.

Don A. Stevens, M.D., medical oncologist with Norton Cancer Institute, is among researchers around the country who have been investigating additional CAR-T cell therapy uses through clinical trials to fight lymphoma. He is encouraged by what he has seen.

“We hope to look at expanding CAR-T’s use for other blood cancers, including myeloma and acute leukemia,” Dr. Stevens said.

How CAR-T cell therapy works

Certain types of cancer usually respond well to chemotherapy, radiation oncology and other treatments. But if a patient doesn’t respond to chemotherapy or the cancer returns, CAR-T cell therapy can offer patients a new treatment option.

In CAR-T cell therapy, a sample of the patient’s immune cells are collected and genetically reprogrammed. Large numbers of the cells are grown in the laboratory before being infused back into the patient. The goal is to reprogram the patient’s immune system to recognize the cancer, prompting cells that have resisted conventional chemotherapy to succumb to the immune system.

T cells (T lymphocytes) have a range of functions, including killing foreign particles and activating other immune cells. After a sample of a patient’s T cells has been collected, the cells are given the gene for chimeric antigen receptor, which the cells then develop on their surface. With this receptor on the surface, the T cells bind to cancer cells and kill them.

“We’ve enrolled patients in several CAR-T trials and have several others we expect to start in the coming year,” Dr. Stevens said. “There are actually several existing CAR-T treatments that have been approved outside of clinical trials, and we’re excited to bring these to our patients.”

About Norton Cancer Institute’s research program

A cancer research program this robust is uncommon in a nonuniversity-based community hospital setting. The Norton Cancer Institute research program’s success hinges on a wide array of clinical and scientific expertise, a strong support infrastructure and multidisciplinary, integrated teamwork.

Clinical trials are vital tools in the fight against cancer. These have become an important link in determining the best new treatments and how therapies are best administered. Cancer represents the single largest segment of Norton Healthcare’s portfolio of more than 800 clinical trials.

The post CAR-T cell therapy triggers the body’s own defenses to fight cancer appeared first on Norton Healthcare.

Depending on how much the cutaneous T-cell lymphoma has spread, the thickness of the lesions and the patient’s baseline skin color, narrowband UVB light and similar treatments have been shown to be as much as 90% effective. Remissions have lasted as long as a year after light treatment.

Norton Cancer Institute has developed a multidisciplinary team to help diagnose and treat this rare type of lymphoma.

Patients with cutaneous T-cell lymphoma typically develop red, scaly — often itchy — patches on the skin, called plaques. The symptoms can be similar to eczema or psoriasis, often resulting in delayed diagnosis.

Cutaneous lymphoma is a rare subtype of non-Hodgkin lymphoma. The cancer cells start in white blood cells (lymphocytes).

For most people, the lymphoma grows slowly and is very treatable. In a small number of patients, the cutaneous T-cell lymphoma can spread to form tumors, and involve lymph nodes, blood and internal organs.

Cutaneous T-cell lymphoma UVB treatment

Jae Y. Jung, M.D., Ph.D., with Norton Cancer Institute and the only oncologic dermatologist in Louisville and Southern Indiana, administers the treatments as patients stand in front of a panel of UVB-emitting light bulbs for several minutes. Patients wear goggles to protect their eyes.

Two or three treatments a week for a few months can reduce redness and scaling, flatten plaques and suspend development of new plaques.

“We’ve seen excellent results when UVB light is delivered consistently over time,” Dr. Jung said. “We select the very narrow UVB band of light to avoid increasing skin cancer risk and burning.”

Sunlight carries an elevated skin cancer risk and can’t deliver the consistent therapy needed to get cutaneous lymphoma to respond. Similarly, tanning beds aren’t a substitute for UVB treatments because they also increase the risk of skin cancer, especially over the long term of treatment that cutaneous lymphoma requires.

Dr. Jung has established a close working relationship with Joseph J. Maly, M.D., medical oncologist with Norton Cancer Institute. Dr. Maly has specific training and experience using immunotherapy, chemotherapy or a combination to treat complicated T-cell lymphoma.

Dr. Maly’s work has made national and global clinical trial efforts available to qualifying patients in Louisville and Southern Indiana.

The post UVB light as a treatment for cutaneous lymphoma appeared first on Norton Healthcare.

The dermatologist biopsied the lump and sent the tissue to the laboratory, and the result came back as non-Hodgkin lymphoma, a blood cancer. Lonnie, then age 31, was floored.

“I never dreamed I would get cancer,” he said. “I was shocked and wondered if I was about to die. I didn’t know where to go from there and was pretty anxious those first few days. But I had my family there to support me.”

Once again, Megan stepped in, helping her husband find specialists to get him the care he needed.

“She said, ‘We’re going to go through this the right way and see the best of the best. Everything is going to be just fine,’” Lonnie said.

Lonnie went to see Norton Cancer Institute oncologist Don A. Stevens, M.D., who ordered a positron emission tomography (PET) scan that revealed his cancer had not spread. Good news there. But the imaging test picked up something else: A suspicious-looking spot in his colon. A gastroenterologist performed an endoscopy and colonoscopy, discovering a large precancerous polyp that would require surgical removal.

This early detection became a lifesaver since the normal age for a colonoscopy is between 45 and 50 years old. Lonnie will have to undergo a colonoscopy annually as a preventive measure.

“I’m very fortunate that the polyp was discovered early,” he said.

For a time, Lonnie’s cancer took a back seat to his colon condition. But after he recovered from surgery in November 2014, the father of three underwent radiation treatments for his lymphoma. Now his condition is monitored but does not require active treatment.

Lonnie gives all of the credit to his wife.

“Megan supported me and directed me to the right specialists,” he said. “Her insistence that I go see the dermatologist saved my life, no doubt about it.”

The post In sickness and in health appeared first on Norton Healthcare.

Lymphomas are cancers of the immune system, which generally arise in lymph nodes and other lymphatic tissue.  The immune system consists of white blood cells, the spleen, lymph nodes and other areas throughout the body.

“In many ways, our skin can be considered our largest immune organ,” said Jae Jung, M.D., oncologic dermatologist with Norton Cancer Institute. “It is designed to defend constantly against viruses, bacteria, and other microbes. When the special immune cells that reside in the skin become cancerous, it can lead to cutaneous lymphoma, a rare type of skin cancer.”

Signs and symptoms of skin lymphoma

Often there are signs and symptoms of skin lymphoma that can be seen or felt. A skin exam by a medical provider helps determine the severity of the cancer. Some of the signs that may be seen or felt on the skin include:

• Patches: may be flat or elevated
• Plaque: can be elevated lesions or a deep thickening of the skin
• Tumor: a solid or rounded lesion greater than 1 centimeter in diameter that has spread deep into the skin
• Erythroderma: widespread, intense reddening of the skin
• Hypopigmentation: patches on the skin that are lighter than your skin tone
• Granulomatous slack skin: loose skin, especially in the body folds
• Pagetoid reticulosis: usually appears as a scaly plaque on the extremities such as the hands or feet
• Leonine facies: extreme thickening of the skin on the face

Related Content: Using the herpes virus to fight melanoma

Treatment options for skin lymphoma

There are a variety of treatment options for skin lymphoma that may be used alone or in combination with other treatments. These include:

• Medications that are applied directly to the skin
• Radiation treatment
• Chemotherapy
• Immunotherapy, which uses a person’s immune system to fight cancer
• Clinical trials for new treatments

While the signs and symptoms of skin lymphoma may be noticed quickly, they can resemble other conditions; so, diagnosis is done through a skin biopsy, a procedure where a sample of your skin tissue is removed and viewed under a microscope, or other lab tests.

Always discuss unusual skin issues with your doctor.

“The best treatment of cutaneous lymphomas is complex, involving both skin-directed therapies (applied directly to the skin) and systemic therapies (treatment that travels throughout the body),” Dr. Jung said. “Ideally, patients should be treated in a multidisciplinary clinic that includes medical oncology, radiation oncology, dermatology, rehabilitation and social services. Fortunately, most cutaneous lymphomas progress slowly and can be treated conservatively with lasting remissions. Although prognosis for patients with aggressive and widespread disease historically has been very poor, new targeted and immune-directed therapies are extremely promising.”

The post Cutaneous lymphoma: Blood cancer that starts in the skin appeared first on Norton Healthcare.

“Hearing you have cancer is like getting hit with a brick, but I’ve been determined to do everything I can to beat it,” Montgomery said.

Fast-forward 19 months, and Montgomery is excited. Thanks to results from this top-tier research, the U.S. Food and Drug Administration (FDA) has granted fast-track approval to Bayer HealthCare Pharmaceuticals for a drug called Aliqopa.

Moreover, Montgomery is thrilled with her results.

“My last scan showed I’m cancer-free at this point!” she said.

Active and healthy throughout her life, Montgomery never expected a routine gynecology checkup would lead to finding out she had a type of blood cancer.

Don A. Stevens, M.D., director of Norton Cancer Institute’s Hematologic Malignancy Program, is Montgomery’s medical oncologist. He explained she has follicular lymphoma (FL), a slow-growing cancer that is treatable but not curable.

Dr. Stevens was among a number of specialists nationwide selected to enroll patients in the national trial to study this breakthrough medication. Its use was studied in patients who had developed resistance to other therapies, an ongoing concern with FL.

“The approval of novel compounds like Aliqopa that offer a safe alternative to existing treatments is good news,” he said.

Norton Cancer Institute’s robust research program gives patients access to advanced cancer therapies. This clinical trial (known as CHRONOS-1) included 104 patients with FL who had relapsed following at least two prior cycles of treatment.

According to Dr. Stevens, the clinical trial’s results were very positive. Nearly 60 percent of patients who participated saw significant shrinkage of their lymphoma as measured by CT scans. Aliqopa’s side effects — high blood pressure, high blood sugar, diarrhea and decreased strength or energy — were generally temporary or manageable.

FL accounts for one in five of the nearly 73,000 new cases of non-Hodgkin lymphoma diagnosed each year. Annually, about 20,000 people die from FL.

“After nine years and several relapses, I’m still here, running my own business and enjoying life,” said Montgomery, a Mary Kay Cosmetics sales manager who loves to travel. “Aliqopa has given me new hope.”

The post Cancer-free patient finds hope from clinical trial appeared first on Norton Healthcare.

Don A. Stevens, M.D., medical oncologist/hematologist and director of the Hematologic Malignancy Program at Norton Cancer Institute, was one of only two physicians in the country able to enroll patients in a national clinical trial to study the new medication.

The FDA granted accelerated approval of Aliqopa (copanlisib) on Sept. 18, 2017, to Bayer Healthcare Pharmaceuticals. Aliqopa is for patients who have received at least two prior rounds of treatment for follicular lymphoma, a slow growing, non-Hodgkin lymphoma.

According to Dr. Stevens,  follicular lymphoma often comes back even after multiple treatments. When this happens, treatment options are limited since patients tend to develop a resistance to previously used therapies. The new drug gives patients another chance.

“While there is some potential to recycle previously used drugs, most are less effective in subsequent courses of treatment,” Dr. Stevens said. “These patients have no cure at this point, so novel compounds like Aliqopa that offer a safe alternative are obviously good news.”

Norton Cancer Institute maintains a robust research program to give patients access to leading-edge therapies. This clinical trial (known as CHRONOS-1) included 104 patients with follicular B-cell non-Hodgkin lymphoma who had relapsed following at least two prior cycles of treatment.

New hope

Brenda Montgomery, a patient of Dr. Stevens from Carrollton, Kentucky, enrolled in the trial in February 2016. Active and healthy throughout her life, Montgomery never expected a routine checkup to lead to a nine-year battle with follicular lymphoma. She also never guessed she would be left with few treatment options after a relapse following her first- and second-line treatments.

“Aliqopa has given me new hope,” Montgomery said. “After nine years and several relapses, I’m still here, running my own business and enjoying life.”

The trial measured how many patients experienced complete or partial shrinkage of their tumors after treatment with copanlisib injections. Results showed 59 percent of patients had a complete or partial response. On average, the response continued for more than one year.

“The results of this clinical trial were very positive,” Dr. Stevens said. “Nearly 60 percent of patients who participated saw significant shrinkage of their lymphoma as measured by CT scans.”

Montgomery beams when she talks about her results: “My last scan showed I’m cancer-free at this point!”

Aliqopa received accelerated approval from the FDA because it filled an unmet medical need for a serious condition. Further clinical trials are required to confirm Aliqopa’s clinical benefit. As the trial sponsor, Bayer currently is conducting these studies.

Side effects of Aliqopa can include high blood sugar levels, high blood pressure, diarrhea and decreased general strength and energy. Low levels of certain white blood cells (leukopenia, neutropenia), nausea, lower respiratory tract infections and low levels of blood platelets (thrombocytopenia) also are possible.

According to Dr. Stevens, most of these side effects proved to be temporary or manageable.

Other potential serious side effects can include infections, inflammation of the lung tissue (noninfectious pneumonitis) and severe skin reactions. Women who are pregnant or breastfeeding should not take Aliqopa because it may cause harm to a developing fetus or newborn baby.

Follicular lymphoma is the most common indolent, or slow-progressing, form of non-Hodgkin lymphoma, a blood cancer that starts in white blood cells called lymphocytes.  Follicular lymphoma will account for one in five of the nearly 73,000 new cases of non-Hodgkin lymphoma that will be diagnosed this year. Each year, follicular lymphoma claims more than 20,000 lives.

The post Norton cancer specialist’s research paves way for new FDA-approved lymphoma treatment appeared first on Norton Healthcare.