Could New Non-Hodgkin Lymphoma Drugs Mean Less Chemo in the Future?

“The new trials are trying to decrease the amount or types of chemotherapy, and decrease the cycles of chemotherapy given, by adding these new agents,” Dr. Julie Vose, medical oncologist at the University of Nebraska, tells SurvivorNet.

In the future, it’s possible that combining one of these newer generation drugs with chemotherapy might help some people cut back on the amount of chemo they need, and avoid some of the side effects, such as hair loss and nausea, in the process.

Here are a few of the new antibody drugs that are being studied to treat non-Hodgkin lymphoma.

Bispecific Antibodies: Two Targets, One Drug

Antibodies are proteins that help your immune system track down abnormal cells in your body, such as bacteria, viruses, or cancer. They’re designed to stick to another protein, called an antigen, on the surface of the abnormal cells. Once attached, antibodies signal your immune system to attack the foreign invader.

Researchers have created man-made versions of antibodies that target a specific type of antigen found on cancer cells. These are called monoclonal antibodies. Rituximab (Rituxan) is an example of a monoclonal antibody that’s currently being used to treat certain types of non-Hodgkin lymphoma, in combination with chemotherapy.

Bispecific antibodies are the next generation of antibody therapies. They’re designed to bind to two different antigens at once. One arm attaches to an antigen on the surface of immune cells called T-cells, while the other binds to an antigen on the surface of cancer cells, and then they pull the two cells together.

“It’s a way to try to get the patient’s own T-cells next to their cancer cells and to bring them into close proximity to help fight the lymphoma,” Dr. Vose says.

Taking a BiTE Out of Lymphoma

BiTE antibodies are another innovation that’s similar to bispecific antibodies. BiTE is short for “bispecific T cell engager.” Like bispecific antibodies, this treatment has two arms.

One arm attaches to a specific protein on the cancer cell, while the other one activates the body’s T-cells to destroy the cancer cells. “It’s a different mechanism of bringing the T-cell closer to the tumor cell,” Dr. Vose says.

Antibody-Drug Conjugates: Delivering Drugs Straight to Cancer Cells

One of the biggest problems with chemotherapy is that it can’t discriminate between healthy cells and cancer cells. Because chemo goes after fast-dividing cells, it also destroys some healthy cells, including hair cells, digestive tract cells, and blood cells. That’s why hair loss, nausea, and infections are common side effects of chemo.

Antibody-drug conjugates help to avoid this problem by delivering the chemo drug straight to the cancer. They’re made up of a monoclonal antibody attached to a drug. The monoclonal antibody binds to a protein on the cancer cell, before inserting the drug into that cell.

One antibody-drug conjugate, polatuzumab vedotin (Polivy), is already being used to treat lymphoma. It attaches to a protein called CD79b on the cancer cells, and then releases a toxin to destroy the cancer.

Polivy is approved in combination with chemotherapy and Rituxan for people with diffuse large B-cell lymphoma that has spread or come back after two other treatments. In those patients, Polivy has “had some success in improving the outcome,” Dr. Vose says. “I’m sure we’ll be seeing a lot more of that particular antibody-drug conjugate, as well as others that are designed in a similar fashion.”

There is another antibody-drug conjugate, loncastuximab teserine, that is being studied in clinical trials. It attaches to a protein called CD19 on your lymphoma cells.

 

Chemotherapy is Still Key

For now, chemotherapy is still an integral part of the treatment for non-Hodgkin lymphoma. While you might get an antibody drug along with chemotherapy, you can’t avoid chemo entirely. Eventually, if researchers find an immune-based therapy that works well enough against lymphoma, it could be used on its own, Dr. Vose says.

In the meantime, there are things you can do to minimize some of the more unpleasant side effects of chemo. Your doctor can prescribe medicines to protect your body’s healthy cells and help you avoid problems like nausea and infections while you’re on this treatment.

Learn more about SurvivorNet's rigorous medical review process.

---