A doctor’s perspective on blood cancer

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This article is sponsored by Loxo@Lilly, the oncology unit of Eli Lilly and Company.

In this special sponsored episode from Loxo@Lilly, I’m joined by Dr. John Pagel, senior vice president of clinical development and global head of hematology at Loxo@Lilly, to discuss blood cancer — what it is, advancements in research and treatment, and his experience in the field.

There are an estimated 1.5 million people in the U.S. living with leukemia and lymphoma, which are types of blood cancer.

In leukemia and lymphoma, white blood cells behave abnormally, and the maturity of these cells determines the type of disease. Abnormalities in immature white blood cells cause leukemia, and abnormalities in mature white blood cells cause lymphoma.

“Somewhere in that process of cell maturation, something can go wrong,” Dr. Pagel says. “They start making too many of themselves. I always think of this like when those white stormtroopers in Star Wars all march.”

Mantle cell lymphoma

There are close to 80 subtypes of leukemia and lymphoma. Mantle cell lymphoma (MCL) is a form of non-Hodgkin lymphoma that arises from a type of white blood cell called B lymphocytes. It is a rare blood cancer that affects the lymphatic system, which helps protect the body against infection and disease.

“Mantle cell lymphoma is one of the more interesting subtypes of non-Hodgkin lymphoma that we address and think about,” Dr. Pagel says. “It has often behaved very aggressively. It is true that people often get chemotherapy for this lymphoma early on, and they get to remission, and they might do well, but they typically will relapse.”

Because relapse is almost universal for people with MCL, many patients will require several lines of treatment. Dr. Pagel says that fortunately, providers now have “a lot of arrows in our quiver of tools” to manage MCL due to recent advancements in research.

There are various approaches to treating MCL, including immunomodulatory and cellular therapies. Inhibition of Bruton tyrosine kinase (BTK), an enzyme that is essential for the normal lifespan of a white blood cell and critically important for the survival of cancerous cells, is also an option. In simplified terms, when cancerous cells grow and divide in MCL, Dr. Pagel says, it is like a light switch has been turned on that won’t turn off. But inhibiting BTK, that critical protein, is one way to address that stuck light switch.

Challenges — and rewards

Although the MCL treatment landscape has grown in recent years, there are still challenges that physicians face in treating and researching this disease and other blood cancers.

Dr. Pagel says that when treating patients, the biggest problem is getting the right therapy to the right person at the right time — so it is critical that patients speak up and find a physician they trust and respect.

“Patients need to be their own best advocate,” Dr. Pagel says. “Do your research, look at your options, talk to your doctor, ask hard questions.”

In terms of hurdles in blood cancer research, Dr. Pagel says that the development of novel therapies can be extremely challenging.

“This process takes a lot of time,” Dr. Pagel says. “Time from discovery of a drug to approval and on the market can take a good decade depending on the drug and depending on the disease.”

Despite the obstacles Dr. Pagel has witnessed in addressing blood cancers, he says he has been lucky to also experience positives over his 25-year career as a physician and researcher, including the special relationships and impact he has been able to have with patients facing life-threatening illnesses.

“People will often ask, ‘How could you go into this field? It’s so depressing, and it’s hard.’ It’s actually completely the opposite,” Dr. Pagel says. “This profession has allowed me to help patients at a level that is really hard to find in any other profession. I’m super lucky and fortunate to have had that kind of opportunity to do that.”

John Pagel is a hematology-oncology physician and senior vice president of clinical development and global head of hematology, Loxo@Lilly.

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