Alternatives to CAR T-Cell Therapy
- CAR T-cell therapy uses your own modified immune cells to fight cancer, but it can have side effects
- Immune therapies and targeted therapies are two other options if CAR T-cell therapy isn’t right for you
- You can access experimental treatments by enrolling in a clinical trial
Yet CAR T-cell therapy isn’t right for everybody with this type of cancer. And no matter how much you might want to try it, there’s a possibility your doctor could tell you that it isn’t a good fit for you.
Read MoreChemotherapy
Several chemotherapy drugs are useful for treating diffuse large B-cell lymphoma (DLBCL), either on their own, or combined with other treatments like immunotherapy. One common regimen nicknamed R-CHOP includes a cocktail of three chemotherapy drugs, plus the antibody-based drug rituximab (Rituxan) and a steroid.This therapy is often given as the first treatment for DLBCL, but there are many different chemotherapy combinations that can be used for DLBCL that comes back after the first treatment, or that doesn’t respond to initial treatment. Combining several treatments into one has the advantage of targeting your cancer in different ways.
You’ll get chemotherapy in cycles, each of which lasts a few weeks. If one chemotherapy regimen doesn’t work for you, your doctor can try another combination of these drugs.
New Immune-Based Treatments
Immunotherapies work with your immune system, essentially training it to go after your cancer. Monoclonal antibodies are designed to home in on a specific protein on the surface of your cancer cells, and mark those cells for destruction.
One of the newest drugs in this category is polatuzumab vedotin (Polivy). Polivy was FDA approved in 2019, in combination with Rituxan and the chemotherapy drug bendamustine, to treat large B-cell lymphoma that has spread or returned after two or more other treatments. It comes as an infusion that you get into a vein once every three weeks. Polivy targets the protein CD79 on the surface of lymphoma cells.
Another type of immunotherapy is tafasitamab (Monjuvi), which is works on the CD19 protein. You might get this medicine together with the drug lenalidomide if your cancer has come back or is no longer responding to other treatments, and you’re not a good candidate for a stem cell transplant.
Targeted Therapies
Another step forward in lymphoma treatment targets substances the cancer cells need to survive. So far, only one targeted therapy is FDA-approved for diffuse large B-cell lymphoma. It’s called selinexor (Xpovio), and it’s a totally new kind of drug called a nuclear export inhibitor.
Xpovio works in the nucleus, the nerve center of the cancer cell. Cancer cells use a protein called XPO1 to move damaging substances out of their nucleus. Xpovio blocks this protein, keeping anti-cancer substances inside the nucleus, where they ultimately destroy the cancer cell.
Into the Future of Lymphoma Therapy
“There are also targeted therapies on the horizon,” Dr. Combie says. “We’re trying to understand if there are certain subtypes of diffuse large B-cell lymphoma that may respond to specific targeted therapies.”
Some of the treatments under investigation are Bruton’s tyrosine kinase (BTK) inhibitors, which target the BTK protein that help lymphoma cells grow and survive. Phosphatidylinositol 3-kinase (PI3K) inhibitors block proteins the cancer cells need to grow. And BCL-2 inhibitors go after a protein that helps lymphoma cells survive.
A lot of these targeted therapies are still in the investigational stage. “We would encourage patients who have their disease come back after CAR T-cell therapy, or who are not eligible for CAR T-cell therapy, to pursue a clinical trial,” Dr. Combie tells SurvivorNet. “That’s where we can offer patients some of these new agents.”
Ask the doctor who treats your cancer whether a clinical trial of an investigational lymphoma drug is appropriate for you. Before you enroll in one of these studies, make sure you understand how the experimental treatment might help you, and what risks it could have.
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