Supported by fellowship, oncologist leads trial of older patients with lymphoma
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Elizabeth Brém, MD, was named a Coltman Fellow to support her work on SWOG’s S1918 trial, designed to assess a reduced-dose chemotherapy regimen in patients aged 75 years or older with newly diagnosed aggressive non-Hodgkin lymphoma.
Brém, an assistant clinical professor in the division of hematology/oncology at UC Irvine Health, said that although newly diagnosed aggressive non-Hodgkin lymphoma tends to occur among older patients, there are limited data on outcomes among patients aged 80 years and older due to several reasons, including trial caps and other eligibility criteria.
“Even though these patients account for one-third of those with newly diagnosed lymphoma, we actually know less about them than we should,” Brém told Healio in an interview. “That’s why we chose to focus on this particular age group.”
Brém and colleagues provided details about the phase 2/3 trial of a reduced-dose regimen called R-miniCHOP — consisting of rituximab (Rituxan; Genentech, Biogen) and CHOP chemotherapy — for this patient population in an article published in Journal of Geriatric Oncology.
According to Brém and colleagues, data have shown that 23% of patients aged 66 years or older and 33% of patients aged 80 years or older do not receive any therapy for newly diagnosed diffuse large B-cell lymphoma, despite data that OS is higher for older patients who receive rituximab-containing regimens.
The 2-year Dr. Charles A. Coltman Jr., Fellowship — supported by The Hope Foundation for Cancer Research, the public charity of SWOG Cancer Research Network — is designed to help early career investigators in learning clinical trial methodology.
“The whole concept of S1918 has been collaborative since the beginning,” Brém said. “We’ve pulled in our colleagues from the other groups, so this is a SWOG-led effort with key pivotal contributions from colleagues. This has been my first big study, so to speak, and it has been nice to essentially have my hand held and be mentored by some wonderful people on the SWOG side and as well as by my laboratory colleagues.”
Choosing oncology
Speaking with Brém about her career path, she said that she felt particularly lucky to have been exposed to both oncology and malignant hematology early on.
“I knew early that I wanted to go into medicine, but when I made that decision, I thought I’d focus on pediatrics or sports medicine, as I had been a dancer for a long time,” she said. “When I was in college I did some basic science research for my mentors. While it was interesting, it was a small college so there was some limitation to what I could do, and I ended up doing a summer program at the local cancer center — the Roswell Park Cancer Institute.”
Brém said that by virtue of the people she worked with, including lymphoma researchers, she was able to see the whole “bench-to-beside” spectrum of caring for patients with lymphoma.
“I would be in the lab doing the pipetting with people who would let me shadow them in clinic, so I got this really comprehensive experience in oncology really early,” she said. “That was huge for shaping my career. From that point forward I was pretty sure I was going to go into oncology and pretty sure I was going to focus on lymphoma.”
Advice for others
Just as the people Brém found herself working with shaped her choices and interests in medicine, she emphasized how important it is to have multiple mentors, especially for the different areas of work and life.
“One thing I learned during my time as a fellow is that almost everybody needs multiple mentors,” she said. “I had a couple of key people, including someone who mentored me on how to take care of patients, in addition to research mentors, and I also found you need someone to mentor you on life and how to balance it all.”
Brém said that she had her first child during fellowship and a second child a couple years into attending. She was able to learn how to juggle her family home life along with clinical care and research by finding those with either similar struggles or who had learned how to develop a personal balancing act.
Besides mentors within the medical field, she said she has found peers and close friends who have been able to help her as they had each other’s backs.
“It’s important to know that you need multiple mentors, know that you need multiple supports and to not be afraid to look outside your institution,” she said.
Between the growing use of telecommunication in medicine since the beginning of the pandemic and growing social media groups for medical professionals, Brém said that it is continuing to become easier to find mentors from all over.
“Don’t be afraid to think outside your institution and don’t be afraid to reach out,” she said. “Have multiple mentors, know that your needs for mentorship are going to change over time and don’t be afraid to ask. The worst-case scenario is that somebody doesn’t answer your email.”
Reference:
For more information:
Elizabeth Brém, MD, can be reached at ebrem@hs.uci.edu.
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