New hope for people with aggressive lymphoma

New hope for people with aggressive lymphoma

New hope for people with aggressive lymphoma

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An experimental five-drug combination significantly improves outcomes for patients with an aggressive cancer of the immune system. Some patients with aggressive B-cell lymphoma achieved complete remission, study researchers say, either because their cancer had recurred or was no longer responding to treatment.

FRIDAY, June 21, 2024 (HealthDay News) — An experimental cancer treatment regimen achieves complete remissions in some patients with aggressive B-cell lymphoma, researchers report.

The five-drug combination does not include chemotherapy. Rather, it simultaneously focuses on multiple molecular pathways that diffuse large B-cell lymphoma (DLBCL) tumors rely on to survive. B-cell lymphoma is a cancer of cells in the body’s immune system. DLBCL is the most common type of lymphoma.

This clinical trial, conducted by researchers at the National Institutes of Health, included 50 patients with DLBCL whose prognosis was dismal. Their cancers had either returned after periods of remission or were no longer responding to treatment.

“Many of these patients who stopped responding to standard treatments would otherwise have died within a year, and now we have a good proportion who are still alive in the last two years and some in the last four years,” said co – the leader of the study, Dr. Christopher Melani. , of the National Cancer Institute (NCI) Cancer Research Center.

The treatment combines five drugs – venetoclax, ibrutinib, prednisone, obinutuzumab and lenalidomide. Using the five initials, it’s called ViPOR, for short.

The drugs were administered simultaneously in two-week cycles with a one-week break between cycles.

Researchers said the regimen substantially shrunk tumors in 26 of 48 (54%) patients evaluated, with 18 (38%) having a complete response. In other words, their tumors disappeared.

At two years, 36% of all patients were alive and 34% were free of disease.

The researchers said the benefits were mainly seen in patients with two specific subtypes of cancer.

“DLBCL is one of the most genetically heterogeneous forms of cancer, and therefore we do not have the ability to identify exactly which drug combination would be most effective for a given patient,” Melani explained in an NCI press release .

But by combining five drugs, the researchers say some combinations — two, three or more drugs — will prove very effective against a particular patient’s tumor.

In the phase 1b/2 study, responses to six cycles of the ViPOR regimen varied by cancer subtype. Complete responses were clustered into two subtypes. This included 62% of people with non-GCB DLBCL and 53% of those with a form known as high-grade B-cell lymphoma.

At two years, participants with these two types of cancer had higher rates of overall survival and tumor progression-free survival than other participants. The researchers said these cancers depend on the survival mechanisms that ViPOR targets.

ViPOR also helped 30% of patients whose lymphomas did not respond to or came back after CAR T-cell therapy achieve durable remissions. CAR T cell therapy involves the patient’s own T cells to help the immune system destroy the cancer. It is the current standard of care for people whose DLBCL has come back.

Compared with standard treatments, the side effects of the five-drug regimen were described as mild to moderate. The researchers said additional drugs could be added to the regimen.

They are studying ViPOR in people with other lymphomas that have resisted treatment and are developing a larger phase 2 study to confirm their findings.

Further research is needed to develop therapies for GCB DLBCL subtypes that have been less responsive to ViPOR.

The findings were published June 20 in the New England Journal of Medicine.

More information

UC Davis Health has more on precision medicine.

SOURCE: National Cancer Institute, press release, June 19, 2024

What does this mean for you?

Researchers are finding more ways to treat stubborn cancers of the immune system.

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