Fifteen Years Together: Mr. Yu’s Cancer Journey With His Care Team

By: Dr. Tran-Der Tan, Director, Stem Cell Transplantation and Cellular Therapy Department

To encourage cancer patients to face treatment with strength and hope, the Taiwan Cancer Foundation has held an annual “Cancer Fighter” selection program since 2007. Now in its 19th year, the program recognizes individuals whose journeys embody perseverance. One of our patients, Mr. Yu, demonstrated remarkable determination throughout his long fight with cancer and was named one of the Taiwan Cancer Foundation’s “Top 10 Cancer Fighters of 2025.” As Mr. Yu’s attending physician, I witnessed the effort, courage, and resilience he showed at every stage of treatment. I am sharing this story to reflect on a 15-year partnership marked by setbacks, breakthroughs, and hard-won hope.

Diagnosis: A Rare and Aggressive Lymphoma

Mr. Yu first came to our hospital in 2010, and I have been responsible for his care since that time. He was diagnosed with mantle cell lymphoma (MCL). In Taiwan, there are about 3,000 newly diagnosed malignant lymphoma cases each year, and only about 3% to 4% are mantle cell lymphoma. That works out to roughly 90 to 120 MCL patients annually, making it a relatively rare subtype.

Most mantle cell lymphoma is highly aggressive. About 75% of patients are already diagnosed at Stage III or Stage IV, with disease that can spread widely through the body. At the time, standard treatment typically combined a CD20 monoclonal antibody (rituximab) with multi-agent chemotherapy, often followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation. Even when treatment went well, disease control typically lasted about 3 to 7 years. If relapse occurred, second-line targeted therapies plus chemotherapy were used to extend survival, with an overall expected survival of roughly 12 to 15 years. For patients unable to complete full treatment, average survival was often less than 5 years.

The First Major Challenge: A Disease Course That Relapsed Too Quickly

After Mr. Yu arrived at our hospital, we chose an intensive regimen that had just been announced by MD Anderson Cancer Center at the time: alternating HyperCVAD and high-dose MTX/ARA-C. This was a high-intensity approach, designed to achieve strong results without requiring additional autologous stem cell transplantation.

Despite that, Mr. Yu experienced his first relapse in under two years. After receiving second-line medication and radiation therapy, his disease stabilized for only about one and a half years before worsening again. Based on published data available at that time, his estimated remaining survival could have been less than two years.

A Second Stroke of Fortune: Access to Compassionate-Use Ibrutinib

At this difficult moment, MD Anderson published results in The New England Journal of Medicine on a new drug, ibrutinib, marketed by Johnson & Johnson, showing that it could be more effective than typical chemotherapy for relapsed mantle cell lymphoma. At that time, the company agreed to provide compassionate-use treatment at no cost to 20 patients in Taiwan, and Mr. Yu was one of them.

Published data suggested that while ibrutinib was a strong option, for relapsed patients the average progression-free survival was about 13 months. For those who responded, the average duration of response was about 18 months, and average overall survival was around 24 months.

Mr. Yu’s outcome once again exceeded expectations. He maintained an unprecedented 62-month period of stability, the longest among Taiwan patients receiving this compassionate-use treatment. Before national insurance coverage began, he relied on the company’s support to receive the medication for free. After coverage was introduced, he was able to continue treatment smoothly. Later, even after he exceeded the insurance reimbursement time window, the company continued providing the medication at no cost until it stopped working.

The Third Low Point: When Ibrutinib Stopped Working

After more than five years on ibrutinib, Mr. Yu’s lymphoma relapsed again. According to published reports, once mantle cell lymphoma becomes refractory after ibrutinib, remaining survival can be as short as about three months.

Fortunately, newer generations of bispecific antibody targeted therapies were emerging internationally, including glofitamab, mosunetuzumab, and epcoritamab. These drugs had shown strong results in other types of lymphoma, but their effectiveness in mantle cell lymphoma was still uncertain, and many clinical trials had already ended.

At this critical moment, a new clinical trial was about to begin for a third bispecific antibody, odronextamab (Regeneron 1979). Only a small number of hospitals in Taiwan participated. Our hospital enrolled the most patients, with five participants in the study. Mr. Yu was the first enrolled and also the highest-risk mantle cell lymphoma patient in the trial.

The Third Turnaround: Complete Remission Within Three Months

The results were deeply encouraging. After three months of odronextamab treatment, Mr. Yu’s PET scan showed a complete response (complete remission). During the course of therapy, treatment had to be paused at times due to complications including infection, low blood cell counts, cytomegalovirus (CMV) reactivation, and CMV-related disease. Even with interruptions, he was able to continue therapy for 18 months.

Later, because of repeated CMV reactivation and the risk of severe infection, we decided to stop the medication while he remained in complete remission. With regular follow-up since then, for nearly five years, there have been no signs of relapse.

Fifteen Years of Partnership: More Than Medicine, a Gift of Life

Over more than 15 years, I have watched Mr. Yu travel repeatedly from Hualien to Taipei for care, each time carrying courage, determination, and hope. Treatment periods sometimes went smoothly and sometimes fell into deep lows, but he continued to push forward. He once told me he believed he might not live to see his child finish elementary school. Today, one child is nearing college graduation, and another is preparing to enter college. These are outcomes no survival curve can truly measure.

Looking back, this journey reflects not only progress in medical science and technology, the support of Taiwan’s health insurance system, and the development of new drugs and clinical trials, but also the goodwill and effort of many people. All the moments that arrived “just in time,” the new medication, the limited compassionate-use slot, the bridge into a clinical trial, felt like more than coincidence. Mr. Yu often says he has deeply felt God’s care along the way. From my perspective, being able to walk beside him through this journey has been a profound gift as well.