Four Things to Know About the Lymphoma Drug Pipeline

For busy healthcare executives, the lymphoma drug pipeline can be both a challenge and a source of optimism. Just keeping up with the latest developments may be daunting, not to mention communicating about them with various constituencies. On the plus side, the latest research continues to bring new hope for patents, families and care providers.

In looking at such advances, here are four things to know.

• CAR T-cell therapy gains attention. Both for results to date and the high costs of achieving them, this emerging treatment should be on every exec’s radar.

“This is perhaps the most exciting development in aggressive non-Hodgkin lymphoma in the last several years,” says Leo I. Gordon, MD, FACP, director of the lymphoma program and co-director of the hematologic malignancies program in the division of hematology/oncology at Northwestern Medicine.  He explains that this novel treatment, offered at only selected sites in the nation, involves manipulating patients’ T-cells (one arm of the immune system) by inserting relevant genes via a viral vector, then re-infusing these altered cells into the patient. This leads to T-cell mediated destruction of aggressive lymphoma and has led to complete responses in 50% of patients who have resistant lymphoma where by comparison, other therapies result in 5% complete responses, according to Gordon. 

At the same time, he notes that toxicity is not insignificant, and the cost to the medical system is currently very high, at approximately $400,000 for the cells. “Further research into this approach is warranted and its place in the spectrum of treatment for aggressive lymphomas has not yet been defined,” Gordon says.

  2.   Inhibitor therapy shows promise in tackling Hodgkin lymphoma.
While adult Hodgkin lymphoma afflicts about 8,500 people yearly compared to more than 74,000 for NHL and more than 75% of all patients diagnosed with it can be cured with combination chemo and/or radiation therapy, HL still poses significant challenges.  In fact over 1,000 deaths are predicted by the end of 2018, according to the National Cancer Institute.  Healthcare execs will be glad to know, however, that additional progress is also being seen on the HL front, with inhibitor therapy one area showing impressive potential.
“This is also an attempt to re-arm the immune system by altering the body’s built in ‘brakes’ in a way that takes frees up our own T-cells and lets them attack the malignancy,” Gordon says. “The results in Hodgkin lymphoma have been extraordinary and we are conduction clinical trials to further develop this treatment.”

  3.  Reductions in toxicity bring positive results. Another important area of research is focusing on drugs that are effective but less problematic than earlier options.
       
“Doctors are finding less-toxic treatments which have fewer serious side effects, yet still cure as many patients as possible,” says David Oubre, MD, founder of Pontchartrain Cancer Center in Covington, Louisiana. “This body of research has potential to have real world implications such as lessening patient financial toxicity, due to decreased hospitalizations, and increasing quality of life.”

  4.  Chemotherapy remains important. While new therapies may garner the most attention, chemo continues to play a major role.  In fact chemotherapy is the main treatment for most patients with non-Hodgkin lymphoma, according to the American Cancer Society.  Examples cited by ACS  include alkylating agents, corticosteroids, platinum drugs, purine analogs, anti-metabolites and anthracyclines.
Combining chemo with other approaches such as radiation or immunotherapy is another option. As just one example, the FDA recently approved the use of Adcetris (brentuximab vedotin) in combination with chemotherapy for treatment of classical Hodgkin lymphoma in selected patients. As research on complementary fronts continues, further broadening of chemo applications seems likely.