Enormous scientific advances are radically transforming lymphoma treatment. If you’re diagnosed with this cancer, your outlook is dramatically better than it would have been 20 years ago.
What you need to know about the many new weapons in the fight against lymphoma…
Lymphoma is a blood cancer that involves cells in the immune system called lymphocytes. There are many different kinds of lymphoma—the main types are Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Some grow so slowly—they are called “indolent”—that doctors may recommend a wait-and-see approach. Others are more aggressive.
Chemotherapy is the primary treatment. If a tumor is localized in one or a few lymph nodes, radiation may be used, but the cancer frequently affects more of the body.
In some cases, more advanced disease may require a combination of drugs and radiation. Surgery is rarely used for lymphoma treatment, although surgical biopsies are used in lymphoma diagnosis.
Unfortunately, the standard chemotherapy drugs—including doxorubicin (Adriamycin), vincristine (Vincasar PFS) and cyclophosphamide (Cytoxan)—kill not just cancer cells but also damage other rapidly dividing cells, such as those in the mouth, intestines, hair follicles and elsewhere. Side effects can include hair loss, painful sores in the mouth, increased risk for serious infection (due to a decrease in white blood cells), nausea, fatigue and “chemo brain.”
The new drugs don’t yet entirely replace these standard agents. But they reflect significant progress in our understanding of the biology behind lymphoma cells’ growth and survival.
THE IMMUNOTHERAPY REVOLUTION
One major advance is a new era in immunotherapy, which uses the immune system’s power to quell cancer. It’s shown progress against different kinds of cancers and is now an important part of many lymphoma treatment plans.
Some approaches to immunotherapy rely on antibodies, compounds made by white blood cells that are one of the principal weapons of the immune system. Their function is to home in on a specific bacterium, virus or other enemy (such as a tumor cell) and tag it for destruction. In some forms of cancer immunotherapy, patients are given monoclonal antibodies synthetically cloned so that they can seek out a specific protein on the surface of malignant lymphocytes. That is, they turn your immune system against the cancer. Immunotherapy may also use other agents, including drugs, to unleash the immune system against the cancer.
The major immunotherapy drugs approved by the FDA against lymphomas and what they do…
- Harnessing the immune system: Rituximab (Rituxan), approved in 1997 against non-Hodgkin’s lymphoma, is a monoclonal antibody that marks lymphoma cells for the immune system to destroy. This drug has been a major contributor to improved outcomes over the past two decades. It also inhibits tumor growth and promotes a process that signals lymphoma cells to die off.
- Magnifying the effect: Obinutuzumab (Gazyva) and ofatumumab (Arzerra) are two more recently approved monoclonal antibodies. Both work like rituximab but have been tweaked to modify their interactions with the immune system.
- Opening the immune gates: Nivolumab (Opdivo), another monoclonal antibody, approved in the treatment of Hodgkin’s lymphoma in 2016, works to block “immune checkpoints.” These are molecules that keep T-cells from attacking normal cells. Lymphoma cells can take over checkpoints for their own nefarious purposes. Monoclonal antibodies and other compounds can be used to neutralize those hijacked checkpoints, unleashing the body’s immune system against the cancer.
- Acting like a Trojan horse: Monoclonal antibodies can also be engineered to deliver cancer-killing chemicals or radioisotopes. Brentuximab vedotin (Adcetris), first approved against lymphoma in 2011, recognizes a protein on the surface of certain cancerous lymphocytes and binds to it. Then it introduces a compound that only becomes toxic inside the lymphoma, causing less toxicity to other cells.
OTHER PROMISING NEW DRUGS
Immunotherapy isn’t the only new thing in lymphoma therapy…
- Honing the attack: Unlike conventional chemotherapy, which targets rapidly dividing cells, new “targeted chemotherapy” drugs disrupt the molecular pathways that cancer cells must maintain to survive. Two drugs—ibrutinib (Imbruvica) and idelalisib (Zydelig)—work this way.
- Helping cancer cells die: Venetoclax (Venclexta), approved in 2016 for a specific type of lymphoma (chronic lymphocytic leukemia), blocks a protein that supports tumor cell survival. Several other drugs that work similarly are now in development.
The search for new ways to treat lymphoma continues. Other innovations include antibiotics to quell infections that promote survival of certain kinds of malignant lymphocytes, and a technique that takes immune cells from the body, genetically alters them to fight cancer, and returns them to circulation.
IS IT LYMPHOMA?
The most common symptom is swollen lymph nodes—lumps, usually painless, that typically appear in the groin, in the armpit, on the neck or along the chin or collarbone. Other symptoms may include persistent fatigue, unexplained weight loss, fever, soaking night sweats, itching, coughing or trouble breathing and pain or swelling in the abdomen. A diagnosis is usually suggested by a physical exam and a profile of symptoms, followed by a biopsy. If confirmed, blood tests and radiology can hone the diagnosis.