In May 2018, Tyler Goodwin underwent CAR T-cell therapy for follicular non-Hodgkin lymphoma (NHL). While he was having preparatory chemotherapy for the procedure, a surprise visitor to his hospital bedside provided a powerful reminder of why this promising new cancer treatment was so important to him.
“It was my daughter Theresa, all made up for her prom,” says Goodwin, a 55-year-old single father of two teenagers treated at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC). “She put on her dress, got her hair and makeup done early, and drove two hours from Maine to Boston so I could see her before the prom that night.”
Such rites of passage are what Goodwin feared he would miss after two cancer relapses in three years. Now, thanks to CAR T-cell therapy that is keeping his NHL in check, he is watching Theresa and his son Tyler Jr. move toward adulthood with newfound confidence. The future looks bright, and so does Goodwin’s revived tennis game.
“I celebrate two birthdays each year now,” says Goodwin, who wears a wristband imprinted with “Survivor CAR T 5/16/18” — marking the date that his T cells, removed earlier for the procedure, were reinfused into his bloodstream as genetically modified cancer-fighters. “The day I was born, and the day my life was saved.”
Trials and tribulations
The journey leading Goodwin to this point began in spring 2016. He felt a “half-golf ball-sized lump” on his pelvis while showering, which scans confirmed as NHL. Chemotherapy near his southern Maine home, overseen in Boston by oncologist Arnold Freedman, MD, of DF/BWCC, soon put the disease into remission — however, a scan six months later revealed that the cancer had returned.
“I thought this form of cancer would just be a bump in the road,” recalls Goodwin. “The second diagnosis was much harder to take than the first.”
This time Freedman recommended an autologous stem cell transplant, preceded by several months of intensive chemotherapy. The grueling regimen is very often effective in NHL patients, but six months after Goodwin’s September 28, 2017, transplant, the cancer returned yet again. Goodwin was crushed, but Freedman assured him there was another option.
A spot had opened up on a clinical trial using CAR T-cell therapy to treat NHL patients, overseen by Caron Jacobson, MD — a specialist in both the disease and the highly-specialized treatment. Patients qualifying for the trial had to have previously relapsed from two different types of treatment. Goodwin’s clinical history made him a perfect candidate, Jacobson says.
“A stem cell transplant like Tyler had does not typically cure follicular NHL, but it usually puts it into remission for much longer than six months,” explains Jacobson, medical director of the Immune Effector Cell Therapy program at DF/BWCC. “What this tells us is that Tyler’s lymphoma is very insensitive to chemotherapy, and has developed some inherited resistance mechanisms to it. If somebody has a chemotherapy resistance, it makes perfect sense to shift to a different treatment. Chemotherapy works by getting into a cell and wreaking havoc, whereas immunotherapies — such as CAR T-cell therapy — do their work from outside the cells.”
In Goodwin’s case, the new approach worked. His tumors quickly began shrinking after his modified T cells were infused, and his strength returned even quicker. At his one-month checkup with Jacobson, he was too weak to walk; after three months, he was back to playing tennis. By summer 2019, he was boogie-boarding and preparing to see Theresa off to college and Tyler Jr. into high school. He also shares experiences and advice with other NHL patients online, offering them hope that they too can respond well to CAR T-cell therapy.
Jacobson and her colleagues, meanwhile, continue seeking genetic answers they hope will lessen the burden on future patients — and spare them the pain of multiple relapses.
“We need to get better at figuring out when someone with a particular lymphoma will respond to a certain therapy,” Jacobson says. “There is something inherent in the genetics of the cell or the tumor-micro environment that holds the key, and patients like Tyler will help us find it.”
Like Jacobson, Goodwin looks forward to the day when CAR T-cell therapy can be identified as a first-line treatment for patients like him. He is proud to be playing a role in this effort, but his favorite role will always be as a father.