In a nutshell
This study reviewed the use of targeted therapies in pediatric non-Hodgkin lymphoma (pNHL).
Some background
Due to improvements in treatments, supportive care, and imaging, more than 75% of pNHL patients can be cured. However, there are still many short- and long-term effects of pNHL treatments, such as chemotherapy. Treatments that are not associated with long-term complications are needed.
Targeted therapies are treatments that target proteins involved in cancer growth. They may also stimulate the immune system to attack cancer cells. Many studies have examined the use of targeted therapies, either alone or in combination with treatments like chemotherapy, in adult NHL. Many targeted therapies are also under investigation for pNHL.
Methods & findings
This study reviewed the different targeted therapies being investigated in pNHL.
Rituximab (Rituxan) is a monoclonal antibody that binds to the protein CD20. This protein is present on more than 90% of a particular type of NHL cell, the B cell. It is present on 100% of Burkitt lymphoma cells, and 98% of diffuse large B cell lymphoma cells. Rituximab leads to cancer cell death. One study reported a 60% response rate when rituximab was combined with the chemotherapies ifosfamide, carboplatin, and etoposide in children with relapsed B-cell NHL or who did not respond to treatment (refractory).
90Yttrium-Ibrutumomab tiuxetan (Zevalin) is a treatment that binds to CD20 and delivers a radioactive substance to the cell. This leads to cancer cell death. In adults, this treatment combined with rituximab led to an 80% response rate, compared to 56% with rituximab alone.
Brentuximab vedotin (BV, Adcetris) binds to the CD30 protein and delivers a drug that leads to cancer cell death. Few studies have examined BV in pNHL. One study of relapsed-refractory patients saw a 64% response rate and a 21% complete response rate (no sign of disease).
Nelarabrine (Arranon) is a treatment particularly toxic to T cell lymphoma. A study in relapsed refractory patients found a more than 50% response rate after a first bone marrow relapse. Negative side effects with this treatment often occur in the nervous system.
Bortezomib (Velcade) is a treatment that blocks the growth of cancer cells. It may also help to make cancer cells more sensitive to chemotherapy. A trial looking at pediatric T-cell leukemia patients showed a 73% response rate.
Other treatments under investigation include small molecule inhibitors. These types of therapies block proteins needed for cancer cell growth. Crizotinib (Xalkori), ibrutinib (Imbruvica), and idelalisib (Zydelig) are under investigation in children.
Nivolumab (Opdivo) is a treatment that blocks the PD-1 receptors on cancer cells. Blocking PD-1 stimulates the immune system to recognize and attack the cancer cells.
The bottom line
This study reviewed the use of targeted therapies in pediatric NHL.
Published By :
Pharmaceuticals (Basel, Switzerland)
Date :
May 19, 2016
