What Are the Treatment Options When Lymphoma Returns?

In the late 1980s and 1990s, stem cell therapy worked pretty well in about one-third of people who received it. But as doctors improved upon the first-line treatment in the early 2000s by combining chemotherapy with the monoclonal antibody rituximab (Rituxan) into a drug cocktail called R-CHOP, stem cell therapy no longer worked as well in the second line. The hunt was on for a new way to treat relapsed non-Hodgkin lymphoma.

Fortunately, several new and improved cancer treatments have been introduced, and other novel therapies are under investigation. “It took us from the 1970s to the late 90s to improve on the four drug combination CHOP, which is still the standard, adding rituximab to that,” Dr. Schuster says. Today, not only have the treatments gotten better, but the pace of new drug development has sped up, he says. Several new immunotherapies have come out, just in the last few years.

Immunotherapy: From Science Fiction to Treatment Reality

One new therapeutic option if your cancer has returned is immunotherapy — harnessing the power of your immune system to go after your cancer. “[Immunotherapy is] frequently discussed in the popular scientific literature,” Dr. Schuster says. “Some of it sounds like science fiction. It’s very cool stuff.”

One group of immunotherapy drugs, collectively known as the monoclonal antibodies, use a protein called an antibody to home in on a target on the surface of cancer cells. Rituxan is one such drug.

A few new immunotherapy drugs have been approved for non-Hodgkin lymphoma in recent years:

• Brentuximab vedotin (Adcetris)
• Polatuzumab vedotin (Polivy)
• Tafasitamab (Monjuvi)

Chimeric antigen receptor (CAR) T-cell therapy is one of the newest high-tech cancer treatments. During this therapy, your treatment team will take your own immune cells, called T cells, and genetically modify and multiply them in a lab so that they attach to proteins on the surface of your lymphoma cells and attack them.

These treatments each work in a slightly different way. And they can be effective for people who’ve tried and failed at two previous treatments.

“We’re coming up with the best approaches for people who were not successfully treated by first- or second-line approaches,” Dr. Schuster says. There are currently two FDA-approved CAR T products for people with diffuse large B-cell lymphoma who have failed two prior lines of treatment.

 

The Fourth Line

Say you've tried three separate treatments and your cancer has come back again. It can be frustrating to face yet another round of treatment, but here again, innovation is your friend.

Soon, another therapy called bispecific antibodies or bispecific T-cell engagers (BiTEs), is likely to be added to the mix, says Dr. Schuster. Unlike monoclonal antibodies, which attach to only one target, bispecific antibodies bind to two targets at once. They essentially pull together your immune cells and cancer cells to help your immune system more effectively treat your cancer.

With so many non-Hodgkin lymphoma therapies available, there’s a much better chance that your doctor will eventually find something that works for your cancer. If you’ve been through several rounds of treatment without success, you can always consider enrolling in a clinical trial of a new and as-yet unapproved drug that be more effective than anything you’ve already tried.

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