Brian Koffman, MDCM
Brian Koffman, MDCM, a family physician who lives in Southern California, said he has “an unwillingness to accept the impossible.”
That attitude has served him well in his battle with chronic lymphocytic leukemia (CLL), a blood cancer that ranks as the most common adult leukemia in the Western Hemisphere and is incurable with current therapies.
Many CLL patients have an indolent form of the disease that requires close monitoring only; median survival for them can exceed a decade. But Koffman for several years has been fighting an aggressive genetic variant of CLL that defied treatment until he entered a clinical trial at the OSUCCC – James.
Since being diagnosed at age 54, Koffman has combated his illness with everything from alternative medicine (e.g., Chinese herbs and changing his diet to vegan) to an emergency splenectomy (spleen removal), to a combined therapy involving the drugs cyclosporin and rituximab, to a stem cell transplant.
The combined drug regimen put him into remission, after which he underwent stem cell transplant at a local hospital in his home state. The transplant kept him in remission for six months.
After relapsing, he sought other options. As a physician who had familiarized himself with medical literature about his cancer, he was aware of John Byrd, MD, a CLL specialist at the OSUCCC – James who was reporting amazing results among patients being treated with ibrutinib in clinical trials.
When the American Society of Hematology (ASH) held its annual meeting in San Diego in 2011, Koffman met with Dr. Byrd and agreed to enroll in an ibrutinib clinical trial at the OSUCCC – James.
“It was one of the best decisions I’ve ever made,” Koffman said. “My form of CLL has a lot of cytogenetic complexities — mutations that give me a poor prognosis — and it would not respond to most therapies. I was basically out of options.”
Koffman entered a clinical trial that involved taking a new drug called ibrutinib.
Early in the trial, Koffman lived in Columbus and later would fly back and forth to Columbus for periodic monitoring.
In February 2013, he completed the yearlong clinical trial and entered a “continuation” trial in which he will take daily ibrutinib and report back to the OSUCCC – James every three months for monitoring.
“With ibrutinib, my swollen lymph nodes started shrinking within a week, and I now have no palpable nodes,” Koffman said. “I feel better, my energy’s improving and I’ve had almost no side effects, just some mild rashes and a little gastrointestinal trouble.”
He offers two bits of advice for patients with a life-threatening illness. One is to “put together the right medical team that includes an expert in that disease, especially if it’s a relatively rare one like CLL.”
The other is to strongly consider entering a clinical trial, “not just because it’s a good thing to do for the community by helping to advance medical science, but also because it may have a significant upside for you as a patient.”
He notes that the OSUCCC – James has “expert teams that are set up to do clinical trials. Dr. Byrd said trials are for patients, not the other way around, and he does everything he can to make sure patients can stay on trials that are proving beneficial. You get the sense that you’re being taken care of there, and not just a check mark in a box.”
“Clinical trials also may have downsides,” he adds, “but ultimately they are the mechanisms for generating medical knowledge that leads to cures.” He goes on to say, “The only way these novel drugs will ever become available to people outside of clinical trials is for more and more qualified patients to enroll in the trials so the drugs can be proven effective and approved by the FDA as standards of care.”
He also is aware that, although some CLL patients are on their second or third course of ibrutinib treatment with no relapses, resistance to the drug could eventually occur for him and others. That’s why still other promising drugs are under development.
“I often say there’s never a good time to get CLL, but there’s never been a better time to get it either, thanks to these emerging targeted therapies,” Koffman said. “I wouldn’t be doing all that I’m doing now without the clinical trials. I’d be in dire straits.”