Targeted Treatments for Rare Cancers
A dedicated clinic at UT Southwestern specializes in diagnosing and treating cutaneous lymphoma.
When most people think of lymphomas, they think of cancers that are linked with the lymph nodes. But lymphomas can develop in other parts of the body as well, such as in the gastrointestinal tract, brain, liver, spleen, or, in the case of cutaneous lymphoma, even the skin.
A skilled team of experts at UT Southwestern’s dedicated cutaneous lymphoma clinic specializes in diagnosing and treating this rare type of lymphoma. The clinic has been in operation for more than five years. Its multidisciplinary approach pairs the dermatology expertise of UTSW’s Heather Goff, M.D., M.P.H., with the hematology/oncology background of Syed Rizvi, M.D., Assistant Professor of Internal Medicine. The duo sees patients in tandem.
“We are able to communicate, collaborate, and formulate a treatment plan so patients can get all the care they need under one roof in one day,” Dr. Goff says, noting that one referral from a patient’s primary care physician will cover both the dermatologist and the oncologist.
The clinic also has a radiation oncologist who specializes in treating cutaneous lymphomas and can see patients that same day. “That’s especially important for patients who are driving long distances,” Dr. Goff says. “We have people driving from as far away as Louisiana, two or three hours away.”
Specialized Team Focuses on an Uncommon Disease
Cutaneous lymphoma is diagnosed in only six people per million every year, and its rarity can make diagnosis difficult. “The average person might undergo six or more skin biopsies before diagnosis,” Dr. Goff says. That’s because cutaneous lymphoma can look like benign skin conditions such as psoriasis, eczema, or allergic contact dermatitis.
“At the cutaneous lymphoma clinic, we see patients in a multidisciplinary setting,” Dr. Rizvi says. “This is helpful because these are uncommon diseases. Having dermatological expertise in addition to medical oncology is important because these diagnoses can be very tricky.”
Working together, Drs. Rizvi and Goff can correlate how biopsied cells look under the microscope with the signs and symptoms a patient presents.
“Cutaneous lymphoma can mimic other conditions, and it’s important to exclude those conditions,” Dr. Rizvi says. “That clinical path correlation is important because not everything that looks the same under the microscope behaves the same way. We want to avoid overtreating or undertreating people. Some diseases don’t require excessive treatment – something local and lower in intensity can work – while others require a more intense approach.”
“We are able to communicate, collaborate, and formulate a treatment plan so patients can get all the care they need under one roof in one day.”
A Rare Disease Needs Specialized Expertise
For most people, cutaneous lymphoma is an early stage lymphoma. “It’s manageable, and it doesn’t affect longevity,” Dr. Rizvi notes. In early stages, doctors can offer patients a range of treatment options:
- Light therapy
- Topical chemotherapy
“For a small percentage of patients, the disease will progress over time, but if it does, we have management options. People should think of it as a chronic disease like diabetes or high blood pressure – it can be managed,” Dr. Rizvi says. Advanced cutaneous lymphoma might be treated with:
- Targeted therapies
- Bone marrow transplant
In these advanced cases, patients might need to combine therapies for the most effective treatment.
Targeted Therapies Spare Most Healthy Cells
For some types of cutaneous lymphomas, targeted therapies are good treatment options. Sometimes called precision medicines, targeted therapies stop cancer from growing and spreading by interfering with specific molecules. These therapies focus on cancerous cells without affecting most of the nearby healthy cells.
“Targeted therapy can lead to excellent responses. Responses can be very dramatic,” Dr. Rizvi says.
One targeted therapy, called brentuximab, acts like a “smart bomb” and kills off cancer cells, Dr. Goff adds. “It has a good effect. With patients with more advanced disease, we’re seeing close to clinical remission.”
Another targeted therapy, called mogamulizumab, is an antibody specific to these cancer cells and leads to their destruction.
“We are in a unique position to manage these patients because we see them in a multidisciplinary setting with more than one physician’s expertise. We have a volume of accumulated experience, and we look at every patient individually. We’re not reflexively treating them,” Dr. Rizvi says.