Patient Profile: Bob Paschke

Coping With Recurrent Hodgkin Lymphoma

By Jo Cavallo

At first, Bob Paschke, 34, wasn't too concerned when he developed a persistent cough three years ago. But when the cough, which started around Thanksgiving and lingered through Christmas, didn’t get any better, he decided to see his doctor. Although a chest x-ray and CT scan showed swollen lymph nodes throughout his chest and lungs, a tissue biopsy of the nodes failed to determine an exact cause of the problem. Finally, a biopsy taken from a swollen lymph node under his arm showed that he had Hodgkin nodular sclerosis, the most common form of Hodgkin lymphoma.

"I was told I had stage 4B, which meant that the disease was widespread," says Paschke. "It was scary to hear the word 'cancer,' but my doctor said that Hodgkin lymphoma is a very curable disease and usually responds well to treatment."

Paschke was put on a chemotherapy regimen of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) for nine months and after just three months on the treatment, he achieved partial remission, by the time the treatment ended, he was in complete remission.

"Everyone thinks that chemotherapy makes you feel worse, but because the cancer was making me so ill, the treatment actually made me feel better. I exercised and continued to work throughout my treatment," says Paschke.

Paschke was feeling so good, in fact, by early spring in 2006, five months after he completed treatment, he decided to change jobs. A week later, a routine exam showed that the Hodgkin lymphoma had returned.

"I never imagined the cancer coming back," says Paschke. "My doctor never prepared me for the thought that the cancer might come back. I guess in the back of my mind I thought it was a possibility, but I was so focused on staying positive and I'd had such a good response to the chemotherapy, I just didn’t think that would happen."

Although Paschke was initially worried about whether the lymphoma recurrence would put his new job and health benefits in jeopardy, he says making the switch was a blessing. "If I had known that the lymphoma was going to come back, I never would have changed jobs, I would have been scared of doing that, but my new boss and [co-workers] were so supportive, I'm glad I did, and my insurance covered the treatment."

Making Choices

What Paschke wasn't looking forward to was undergoing the autologous bone marrow transplant his doctors were recommending. Although the procedure left Paschke fatigued, it put him once again in remission. But when the Hodgkin lymphoma recurred a year later and his doctors suggested a nonmyeloablative allogeneic stem cell transplant, Paschke decided to look for an alternative treatment.

"My doctors said there were no other options and I felt a lot of pressure to do the transplant, but I didn't have any confidence that it would work and I didn't have a related donor match," says Paschke. Instead, Paschke started researching Hodgkin lymphoma on the Internet and sought the advice of several lymphoma specialists. One of those specialists, a doctor at the Mayo Clinic in Paschke's home state of Minnesota, suggested that a phase I/II clinical trial he was conducting of two oral medications, everolimus (RAD001) and Nexavar (soranefib), might be effective against his Hodgkin lymphoma.

"The trial was attractive to me, because it involved taking two pills on an ongoing basis with minimal side effects and I thought why not try this?," he says. Within 60 days of starting the trial, Paschke was back in remission. Unless unexpected side effects develop, Paschke will stay on the combination therapy until December.

"My key messages to lymphoma patients are always keep hopeful and keep searching for other choices. Be proactive and find a good support network," says Paschke

To learn more about LRF's Clinical Trials Information Service, click here.

To learn more about Hodgkin Lymphoma, click here.

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