After decades of relying on chemotherapy to treat patients with lymphoma, clinical research is exploring a more targeted approach that would combine high-efficacy with minimal adverse events. This includes, small-molecule inhibitors, immune checkpoint inhibitors, antibodies, and CAR T-cells that exploit cancer-specific targets, in contrast to chemotherapy, and will kill the tumors while sparing healthy tissue.
Recently, a number of such therapies have received approval for the treatment of lymphomas and other chemotherapy-free regimens are being explored. The topic was also discussed at several hematology meetings, including the symposium organised by the Lymphoma Hub at the International conference on malignant lymphoma (ICML) dedicated to the advancement of chemo-free approaches.
This month, through a series of articles, the Lymphoma Hub will take a closer look at chemotherapy-free treatment strategies for indolent non-Hodgkin lymphoma (iNHL) and mantle cell lymphoma (MCL). Let’s start this educational theme by recapping on some of the relevant articles and video interviews that we covered earlier this year.
The phase III trial published in the Journal of Clinical Oncology investigated the efficacy of lenalidomide plus rituximab in patients with relapsed/refractory (R/R) iNHL. Superior efficacy of lenalidomide and rituximab combination was reported, compared to placebo plus rituximab in patients with R/R marginal zone lymphoma (MZL) or follicular lymphoma (FL).
Mark Roschewski from National Cancer Institute, Bethesda, US, reported the results of a phase Ib/II clinical trial using the first-in-class antibody HU5F9-G4 (5F9) that targets CD47, a macrophage immune checkpoint. The antibody was used in combination with rituximab to treat patients with iNHL. The combination was well tolerated and showed efficacy in R/R diffuse large B-cell lymphoma (DLBCL) and refractory FL.
At the 2019 ASCO Annual Meeting, Maria Lia Palomba from Memorial Sloan Kettering Cancer Center, New York, US, discussed the initial results of CAR T-cell therapy for lymphoma, and the current advancements in the field. This includes more powerful cytokine-secreting CAR constructs being developed, as well as the combinations of CAR T-cells with anti-PD1 or anti-PDL1 antibodies.
Fast & furious: looking ahead to next-generation treatments & new combinations in lymphoma?
During ICML 2019, Sattva Neelapu from MD Anderson Cancer Center, Houston, US, talked about the potential of CAR T therapy to deliver long-term benefits to patients with NHL, including how some of the patients achieve long-term benefits with just a single infusion.