Too Busy for Cancer

An innovative clinical trial for high-risk Hodgkin lymphoma enables one energetic 11-year-old to sail through therapy.

Confetti falls and employees sing as a St. Jude patient celebrates her last chemotherapy treatment.

Confetti falls and employees sing as Mary Browder Howell 
celebrates her last chemotherapy treatment.

 

During the past few months, Mary Browder Howell has ridden horses, paddled a canoe, climbed rock formations, played golf and tennis, captained a sailboat, maintained a 100 average in schoolwork and competed in the world finals of a problem-solving competition. She has also undergone treatment for high-risk Hodgkin lymphoma.

“I’m too busy to have cancer,” explains the 11-year-old, with a dazzling smile.

Fortunately, an innovative clinical trial at St. Jude Children’s Research Hospital has enabled this energetic preteen to sail through therapy—all without missing a single ballet rehearsal with her dance troupe back in Kentucky.

Monika Metzger, MD, with patient Mary Browder Howell

Monika Metzger, MD, of St. Jude Oncology enrolled Mary Browder Howell in a new clinical trial for children with high-risk Hodgkin lymphoma. The regimen enabled Mary Browder to avoid the nausea, vomiting, pain, fatigue and radiation therapy usually associated with Hodgkin treatment. 

Concern to consternation

Last winter, Renee and Jason Howell were concerned when their high-spirited daughter fought off two bouts of pneumonia within six weeks, losing several pounds, running a low-grade fever and feeling lethargic. But concern turned to shock when an X-ray and CT scan revealed tumors in Mary Browder’s neck and chest.

“I knew something was wrong, but you never think your child is going to have cancer,” Renee says.

Their pediatrician encouraged the couple to take their daughter to St. Jude.

“It’s ironic,” muses Mary Browder. “About 30 minutes before we got the call saying we were coming to St. Jude, Mom had signed my sister’s Math-A-Thon permission slip.”

During the next few weeks, kids in Mary Browder’s school district would show their support by raising $35,000 for the hospital through St. Jude Math-A-Thon, an education-based fundraising program.

What is Hodgkin lymphoma?

  • Hodgkin lymphoma is a cancer that starts in the lymph system (part of the immune system) and causes affected lymph nodes to get larger.
  • Hodgkin lymphoma accounts for about 6 percent of all pediatric cancers.
  • 6,000 to 7,000 new cases of Hodgkin lymphoma are diagnosed annually in the U.S.
  • Children younger than age 5 rarely develop Hodgkin lymphoma.
  • Hodgkin lymphoma is more common in boys than in girls.

Devious disease

The Howells learned that Mary Browder had Hodgkin lymphoma, a cancer of the lymph system. St. Jude pathologists classified her disease as advanced, or high risk, because the tumors were accompanied by fevers, fatigue and weight loss.

Monika Metzger, MD, of St. Jude Oncology, says the gradual, nearly imperceptible onset of symptoms is typical.

“Hodgkin lymphoma is a sneaky, slow-growing cancer that almost resembles a chronic disease,” Metzger explains. “Many times, patients don’t even realize how sick they feel, because they may have had it for a year or more before they’re diagnosed. When they start chemotherapy, they actually feel energized. It’s like putting on a new pair of glasses and realizing how bad your eyesight was before.”

The standard treatment for Hodgkin lymphoma includes treatment with vincristine, a drug that kills cancer cells but also causes nerve pain. Children may also receive radiation therapy, which can cause long-term problems such as secondary cancers and heart problems. And the risk of infertility is high in many Hodgkin treatment regimens.

A new clinical trial at St. Jude aims to change that scenario.

Just before Mary Browder arrived in Memphis, Metzger opened a clinical trial for children with high-risk Hodgkin lymphoma. Not only does the study eliminate the pain-causing vincristine, but it also eliminates or drastically reduces radiation therapy and offers a low risk of infertility.

“When Dr. Metzger discussed this study with us, we literally jumped at the opportunity,” Jason says. “We had been so concerned about the radiation issues. Since we had the luxury of being at St. Jude, we virtually took for granted the baseline quality of care. We viewed Dr. Metzger’s study as an opportunity to enhance this quality of care even more. I cannot imagine a reason to deny our daughter that type of gift.”

One-two punch

The new clinical trial replaces vincristine with brentuximab vedotin, a drug that delivers a one-two punch to cancer cells. First, a monoclonal antibody seeks out a Hodgkin lymphoma cell and attaches itself to the cell’s surface. Then a second drug moves in for the kill. The St. Jude clinical trial is the first pediatric study to incorporate this antibody into frontline treatment.

“For a long, long time,” Metzger says, “I’ve been trying to do something novel with Hodgkin lymphoma treatment. This drug was specifically approved for Hodgkin lymphoma, and it has had amazing results in adults with relapsed and refractory disease.”

Children who respond to the antibody treatment may avoid radiation therapy altogether. If radiation is required to kill remaining cancer cells, the children receive a highly targeted treatment.

“We irradiate only the affected lymph nodes,” Metzger says. “So the selected patients who do need radiation get only a minimal fraction of what they would have gotten even five years ago.”

Bald, busy, beautiful

From the moment of diagnosis, Mary Browder and her family made a conscious decision to embrace a positive attitude.

“We told Mary Browder that she could define her experience with cancer and its treatment, or she could let it define her,” Jason recalls. “She seized this concept immediately and put it to work in dealing with things internally, but also in dealing with the focus and attention from friends, family members and even strangers. She has owned this experience through this approach.”

The Howells’ efforts to increase their daughter’s comfort level set the tone for navigating the challenges ahead.

Throughout treatment, Mary Browder blogged with her classmates back home, excelled at her schoolwork, devoured mystery and mythology books, worked hundreds of crossword puzzles and returned home for dance rehearsals. She learned to give herself injections. She even rocked her bald head.

“I am now officially BALD,” she wrote in early February. “This morning we went to have my head shaved, but first we got to see what I would look like with a whole bunch of different types of hairstyles. It was really fun to see myself with bangs, pixie, bob, and my personal favorite, a Mohawk.”

Her beautiful, bald head became a palette. Mary Browder encouraged her friends and family to paint shamrocks, polka dots, flowers, purple ribbons and a Charlie Brown caricature on her head.

Mary Browder Howell's ballet class

Mary Browder Howell (fifth from left) never missed a ballet rehearsal during therapy for high-risk Hodgkin lymphoma. 

“For a long, long time,” Metzger says, “I’ve been trying to do something novel with Hodgkin lymphoma treatment. This drug was specifically approved for Hodgkin lymphoma, and it has had amazing results in adults with relapsed and refractory disease.”

Children who respond to the antibody treatment may avoid radiation therapy altogether. If radiation is required to kill remaining cancer cells, the children receive a highly targeted treatment.

“We irradiate only the affected lymph nodes,” Metzger says. “So the selected patients who do need radiation get only a minimal fraction of what they would have gotten even five years ago.”

Bald, busy, beautiful

From the moment of diagnosis, Mary Browder and her family made a conscious decision to embrace a positive attitude.

“We told Mary Browder that she could define her experience with cancer and its treatment, or she could let it define her,” Jason recalls. “She seized this concept immediately and put it to work in dealing with things internally, but also in dealing with the focus and attention from friends, family members and even strangers. She has owned this experience through this approach.”

The Howells’ efforts to increase their daughter’s comfort level set the tone for navigating the challenges ahead.

Throughout treatment, Mary Browder blogged with her classmates back home, excelled at her schoolwork, devoured mystery and mythology books, worked hundreds of crossword puzzles and returned home for dance rehearsals. She learned to give herself injections. She even rocked her bald head.

“I am now officially BALD,” she wrote in early February. “This morning we went to have my head shaved, but first we got to see what I would look like with a whole bunch of different types of hairstyles. It was really fun to see myself with bangs, pixie, bob, and my personal favorite, a Mohawk.”

Her beautiful, bald head became a palette. Mary Browder encouraged her friends and family to paint shamrocks, polka dots, flowers, purple ribbons and a Charlie Brown caricature on her head.

Between medical treatments, Mary Browder and her family visited Graceland, the Stax Museum of American Soul Music, the Memphis Zoo, the Pink Palace and the Rendezvous restaurant.

“We adjusted her chemotherapy schedule so that treatment didn’t interfere with her life and her activities,” Metzger says.

Limitless possibilities

In spite of that frenetic schedule—perhaps because of it—Mary Browder remained upbeat throughout her treatment. It helped that the clinical trial enabled her to avoid nausea, vomiting, pain, fatigue or radiation therapy.

In late May, she celebrated her last chemotherapy treatment—and then hopped in the car to travel to Iowa for the world finals of an academic problem-solving competition.

“We were told that the drug combination could potentially decrease the risk of nausea and vomiting as well as decrease pain. This held true in Mary Browder’s case,” Renee observes. “Another great ‘side effect’ was the reduced need for radiation following chemo. Mary Browder had scans after the second round, and it was found that she would not need any radiation. This was wonderful news, as radiation can have the risk of secondary cancers later in life.

“Overall, her quality of life was maintained during treatment, while at the same time, hopefully, curing her of this disease,” Renee says.

Now, the girl who is “too busy to have cancer” is looking for other exciting activities to pursue. There’s no doubt she will find them.

Abridged from Promise, Autumn 2014

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