Dr Brian Bird
Consultant Medical Oncologist, Bon Secours Health System
Pictured above: photomicrograph of a diffuse large B-cell lymphoma (DLBCL) a type of non-Hodgkin lymphoma.
A novel class of drugs holds promise for patients with diffuse large B-cell lymphoma who don’t respond to first line treatment or relapse.
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma and over 800 people are diagnosed with it in Ireland each year.
However, a third of patients don’t respond to first line treatment or relapse and the options for them are limited.
There has been considerable interest in CAR-T therapy in recent years. The treatment, which involves programming a patient’s immune system to target the cancer by re-infusing genetically edited T cells, certainly holds great promise, but it isn’t suitable for everyone. It’s challenging and extremely expensive.
Dr Brian Bird, Consultant Medical Oncologist at Bon Secours Health System, is keen to highlight other, potentially more accessible, new treatments.
“There are more options for elderly people who don’t respond to first line chemotherapy or where a transplant hasn’t worked or isn’t an option. The one that’s going to be most relevant to the greatest number of people are antibody-drug conjugates,” he confirms.
As it currently stands, the first line treatment for most DLBCL patients is a combination of chemotherapy drugs known as R-CHOP.
For patients who don’t respond or relapse, the next option is an autologous hematopoietic stem cell transplant followed by high dose chemotherapy.
Transplants are lengthy, risky and not generally considered for anyone over 70.
“Of the third of people who relapse, only half of those will be fit to start a transplant and only half of those will be cured. That leaves us with an unserved population,” confirms Dr Bird.
For this “unserved population” there are few alternatives, which is why trials currently taking place into antibody-drug conjugates (ADCs) are so exciting.
This novel treatment combines powerful cancer drugs with an antibody that allows them to be delivered directly to cancer cells, which limits damage to healthy cells.
Benefits of antibody-drug conjugate
ADCs are already licensed for use in the US and EU but not reimbursed in Ireland and Dr Bird believes they could bring fresh hope to forgotten patients with DLBCL in Ireland.
“It seems to be well tolerated in frail and elderly patients with co-morbidities. I don’t think it’s a cure for the majority of patients, but it’s a very helpful drug in terms of prolongation of life,” confirms Dr Bird.
Other research is taking place into therapies, such as cell signal blockers, other antibodies, bispecific antibodies, and checkpoint inhibitors, that have already been used to successfully treat other lymphomas.
However, Dr Bird is hopeful that the phase three trial currently taking place into the efficacy of ADCs in first line DLBCL will mean that patients in Ireland could benefit within the next few years.
“I do think that drugs like this are important advances in this population and would be optimistic that it may move into earlier lines of treatment, should the clinical trials be positive” he concludes.
Veeva no- M-IE-00000106
Date of preparation- June 2020