Chapter 08: 
Research on Lymphoma Treatments

Title

Chapter 08: Research on Lymphoma Treatments

Files

Loading...

Media is loading
 

Description

In this segment, Dr. Rodriguez describes studies she conducted on lymphoma treatments in collaboration with Dr. Cabanillas. She first explains a study that showed the efficacy of ifosfamide among patients who did not respond to the CHOP treatment. She next talks about use of the same drug for patients awaiting stem cell transplantation. This study is still in regular use. Dr. Rodriguez then says that the current atmosphere at MD Anderson focuses on developing new drugs rather than optimizing older drugs. As an example of the value of retaining older ideas, she mentioned work by Dr. Wilson that shows that continuous infusion of drugs is more effective than bolus administration, an idea that Dr. Cabanillas originally explored.

Identifier

RodriguezA_01_20150220_C08

Publication Date

2-20-2015

City

Houston, Texas

Topics Covered

The Researcher; The Researcher; Discovery and Success

Transcript

Tacey A. Rosolowski, PhD:

Yes. OK, so that was really the watershed moment, it’s, like, OK, I’m moving on. And then this Medical Director opportunity comes, and you excelled in that area. So what were you thinking about now? You know, you’re kind of redirecting your MD Anderson career. So how did you begin to think about that? What was the next opportunity you looked for?

Alma Rodriguez, MD:

Well, like all other junior faculties, you look at what is it that’s going to get me to my promotion. To the next promotion. And essentially, you know, you have to write papers, you have to collaborate in research protocols, get some funding for your work, and whether it’s from pharmaceutical grants, or NCI [National Cancer Institute] funded research protocols, so essentially that’s what I really focused a lot of my attention to; how am I doing, who am I collaborating with.

Tacey A. Rosolowski, PhD:

Because you shifted your research focus at this time. So how long did it take you to settle on a new research project, or do an arena of research projects?

Alma Rodriguez, MD:

Well, that wasn’t difficult, because Dr. Cabanillas, like I said, really was passionate.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

So we were literally turning out protocols after protocol after protocol.

Tacey A. Rosolowski, PhD:

Wow.

Alma Rodriguez, MD:

That was not difficult at all, I mean, we were short-handed in terms of the number of people who could do all the clinical studies.

Tacey A. Rosolowski, PhD:

Wow.

Alma Rodriguez, MD:

It was a very rich time in terms of the development of new combinations of chemotherapeutic agents that were successful. So that’s what we did, write protocols, conduct the clinical trials, report out, present at the national meetings, etc.

Tacey A. Rosolowski, PhD:

And what were some key studies that you worked on there, on things that would be relevant to talk about here?

Alma Rodriguez, MD:

Well, at the time, so Dr. Cabanillas had done some early work with a drug called ifosfamide, and shown that in some patients with large cell lymphoma who, unfortunately, their tumors might not respond as well as they should to the best front-line regimen, which at the time was a regimen called CHOP [Cytoxan, hydroxy doxorubicin, Oncovin, Prednisone]. It still is, actually, the golden standard today. It hasn’t shifted much, it still is one of the golden standard regimens. So if the patients didn’t do so well with CHOP, if they were treated with this drug called ifosfamide, some of them responded further and went on to achieve complete remission. So we did a number of studies using ifosfamide base combinations. At that time, we were also starting to do stem cell transplants, so we explored the use of ifosfamide in high doses as what we call an induction regimen for stem cells. And actually, ifosfamide base combinations are still—are today still the pre-stem cell transplant induction regimens of choice for large cell lymphomas. There’s been some tweaking to them. But they still are, at this point in time.

Tacey A. Rosolowski, PhD:

And that’s at other institutions here, and at other institutions?

Alma Rodriguez, MD:

Mm-hmm [affirmative].

Tacey A. Rosolowski, PhD:

Yeah? Wow.

Alma Rodriguez, MD:

So some of that seminal work was at that time. We also showed the benefit of a combination of a drug called Cytarabine and Cisplatin, and that’s another regimen that’s still in use today. So that was in the early—in that face of shifting focus in my career. Later on, and even to today, the attention now is more to the introduction of very new investigational agents into the trials. It’s ironic, but relatively more attention is being paid to new drugs versus exploring, perhaps, optimization of old drugs. Now, let me say that one person who has done just that is at the National Cancer Institute, Dr. Wyndham Wilson. He actually took the exact same combination of the CHOP and he altered it in ways that we had advocated before. We had said, you know, drugs by continuous infusion do better. Dr. Cabanillas had been pooh-poohed for that. Dr. Wyndham Wilson took that to heart, and he redesigned the protocols. And he has shown that really, continuous infusion of certain drugs really does yield better results.

Tacey A. Rosolowski, PhD:

Wow. Why was that not seen as a good idea before?

Alma Rodriguez, MD:

I really don’t know. Perhaps we didn’t design the studies well enough to be convincing, but we had tried—in fact one of our—to this day, I consider the continuous infusion of certain medications to be much safer than the bolus administration. And that’s been shown in studies. But in the community of oncology, because the bolus—the rapid flush administration is much more efficient, less time-consuming, it can be done in the clinic, that sort of has stayed as the standard. But infusional administration of particularly some of the very toxic drugs can be safer for the patients. Very interesting—

Tacey A. Rosolowski, PhD:

Yeah. Yeah.

Alma Rodriguez, MD:

Issues going on in research, but—

Tacey A. Rosolowski, PhD:

Huh. What makes sense to talk about now? I mean, we’ve kind of, you know, have been following the theme of your research, and I know that your research kind of shifted some direction, or maybe you added new dimensions to it as you began focusing—your career took its shift to administration. Would you like to talk about some of those studies? Or would you like to talk about some of the new administrative promotions that you had?

Alma Rodriguez, MD:

Well, I have to go give a presentation at noon.

Tacey A. Rosolowski, PhD:

Oh, OK, so—

Alma Rodriguez, MD:

And so we have only about, what, ten minutes, fifteen minutes?

Tacey A. Rosolowski, PhD:

Right. Right. Would you like to stop now? Do you need some time to prep? Or—

Alma Rodriguez, MD:

I just probably am going to need some time to travel.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

Because these days we have to go from one place to another.

Tacey A. Rosolowski, PhD:

Right, I mean, because we’re kind of at a natural stopping place right now. Does that make sense?

Alma Rodriguez, MD:

Yes, that’ll be fine.

Tacey A. Rosolowski, PhD:

OK, well, then I want to thank you for your time today.

Alma Rodriguez, MD:

Oh, you’re welcome. Thank you.

Tacey A. Rosolowski, PhD:

That’s a very neat story. And I am turning off the recorder at about quarter of twelve.

Alma Rodriguez, MD:

OK.

Tacey A. Rosolowski, PhD:

All right.

Conditions Governing Access

Open

Chapter 08: 
Research on Lymphoma Treatments

Share

COinS