Clinical/Translational Research
It is an exciting time of new hope and challenges. Stanford’s Multidisciplinary Cutaneous Lymphoma team including our faculty, staff physicians, clinical/research fellows, and students would like to update you on our activities and thank you for your thoughtful and generous support of our clinical and research endeavors. We have been very active in the last few years in the development of new techniques and tools to help us diagnose skin lymphomas or detect any spread to sites other than skin. We have also made important progress and contribution towards the development of new therapies that are or will be available to our patients with skin lymphomas.
The Stanford Cutaneous Lymphoma Collaborative Team has three major categories of research focus: epidemiology/clinical outcomes, newer/better diagnostic/staging/prognosticating tools, and development of new/novel therapies. Our research is an end product of intense and interactive collaborative work among the members of Dermatology, Radiation and Medical Oncology, Surgical and Dermatopathology, Diagnostic Radiology, and Blood and Marrow Transplantation.
Dr. Youn Kim continues to serve as the overall Director of Stanford’s multidisciplinary cutaneous lymphoma clinical and research programs. Dr. Rich Hoppe is the Co-Director along with Dr. Ranjana Advani.
- Clinical outcomes research establishing predictive factors of survival, disease progression, and clinical response to therapy. Stanford has led the field in outcomes research and our work is a measuring rod for other centers, nationally and internationally. Stanford holds the largest, longitudinal database for outcomes research. Our results are used to help revise/update staging systems, predict survival and treatment outcomes.
- Establish newer and better diagnostic, prognosticating, and staging tools. As part of our collaborative research with Pathology and NCI, we are using newer molecular and bioinformatics tools to explore genetic (cDNA and tissue microarrays), protein and small molecule RNA expression profiles in cutaneous lymphomas. This information will help us establish new diagnostic and prognosticating markers that are more sensitive and specific for diagnosis and that can be used to predict disease course (prognosis) or response to specific therapies (“molecular targeting of therapies”). We also hope to incorporate these tools and results into imaging studies to help identify disease sites that are not detectable with current modalities. We have also worked with diagnostic radiology and nuclear medicine colleagues to establish the superior utility of the newer integrated PET/CT information to detect disease spread (from skin to internal sites) earlier than conventional imaging techniques. Stanford has led this work and the pilot results have been used to update guidelines for staging in cutaneous lymphomas. We are continuing this research and incorporating a more targeted PET probe technology and better image guided sampling of suspicious sites. Earlier detection leads to more prompt and proper therapy adjustments to improve survival and quality of life.
- Therapeutic trials and translational research to develop newer and better therapies. Conventional therapies have limited efficacy with less than ideal responses and duration of response, and undesirable toxicities. Thus far, there are no reliable curative therapies for most cutaneous lymphomas. Stanford’s key goal is to develop new immunotherapies to bring us closer to curing lymphomas. In collaboration with Dr. Ron Levy in Medical Oncology, we have launched our first human phase of in situ vaccination trial that uses a new/novel immune stimulant (CpG) and low-dose radiation. Applying this combination treatment to a target lesion leads to induction of a systemic immune response against tumor antigens/cells. This leads to a clinical response not only in the target lesion, but more importantly, to all skin and other sites affected with lymphoma. We are now treating our third MF patient and the results are promising. We have also started some ground work to develop a T-cell receptor idiotype vaccine for patients with MF (preclinical work in Dr. Ron Levy’s lab). This is being considered for human application where the clinical team steps in to complete the translational research.
Stanford’s Cutaneous Lymphoma group also leads in therapeutic trials in collaboration with other academic centers and industry. Stanford has been involved in clinical trials that have resulted in FDA approvals for patient use. This is a new era where there are multiple promising new therapies that are under clinical development and in various phases of human trials. We are playing a key role in each of these important drug developments.
Stanford is focused on leading the efforts in “molecular targeting” of therapies in cutaneous lymphomas. This is where using the state-of-the-art molecular tools, we characterize/profile patients’ cutaneous lymphoma at the molecular level (gene expression patterns) and try to match the treatments that can affect the patients’ abnormal gene expressions to become more normal. We and others are beginning to look at how certain drugs affect gene expression profiles in patients. This will take decades to perfect, but Stanford hopes to start and lead the effort. We strongly believe that improved targeting of therapies linked to individually tailored treatment strategies is definitely a sure road to smarter therapeutic management of cancer including cutaneous lymphomas.
In collaboration with our faculty colleagues in Blood and Marrow Transplantation service at Stanford, we are developing more appropriate induction and preparatory regimens for allogeneic blood stem cell transplantation. Despite the risk and severity of allogeneic transplants, we and other have shown that this treatment is a potentially curative solution for patients with very advanced disease.
The Multidisciplinary Cutaneous Lymphoma Team at Stanford is dedicated to providing the best clinical care, and to pursuing the collaborative research endeavors that will improve the quality of our patients’ lives and bring us closer to curative therapies.
