Non-Hodgkin’s Lymphoma: New Medicines that Address Patient Needs

August 14., 2023

Sponsored by Genentech, a member of the Roche Group

OncLive: What are some of the treatment challenges that people with non-Hodgkin’s lymphoma (NHL) face when their disease relapses or becomes refractory to treatment?

Patel:

For patients who have experienced multiple relapses, the prospect of undergoing another round of treatment can be daunting. Depending on the patient’s health, fitness, and goals, and the type of NHL being treated, there can be numerous potential treatment pathways. While chemoimmunotherapy has been the standard treatment approach for quite some time, additional treatment options are needed for patients with both aggressive and indolent lymphoma as they progress through lines of therapy.

Continuous therapy (or treat-to-progression) has been commonly used for managing relapsed/refractory (R/R) NHL in certain patient populations. However, hematologists should be aware of other options. One in particular is fixed-duration treatments, for which I have been involved as an investigator in clinical trials evaluating their use.

What does it mean that a cancer treatment is fixed-duration and how does it impact patients?

A fixed-duration treatment approach may allow the patient to look forward to a period of time without treatment. Knowing how long their treatment will last – and that they can stop therapy while their disease is in remission and potentially maintain the remission. Also, some fixed-duration treatments have the potential to be administered in an outpatient setting. With fixed-duration treatment approaches, patients may be able to avoid the need to return indefinitely to a specific treatment.

How have people with NHL been treated historically and what are some recent advances in the field?

Chemoimmunotherapy has been the most common approach for the treatment of NHL. However, novel immunotherapies including CAR T-cell therapy and T-cell engaging bispecific antibodies, among others, have been developed in recent years. Part of a novel class of immunotherapy, T-cell engaging antibodies have shown great promise in clinical trials in treating patients with R/R NHL.

What is the role of T-cell engaging bispecific antibodies in the treatment of people with NHL?

How can this type of therapy address patients’ specific needs?

T-cell engaging bispecific antibodies are a type of off-the-shelf immunotherapy that may provide different therapeutic options for patients with difficult to treat cancers and those that have a high likelihood of recurrence. Some are already approved for patients whose cancer has relapsed or has not responded to other treatments, and others are in development for those who are newly diagnosed. Some T-cell engaging antibodies are designed to be given as fixed-duration therapies, providing patients with an option that allows them to have a finite course of treatment.

Unlike CAR T-cell therapy, T-cell engaging bispecific antibodies do not require a manufacturing process that involves cell collection and genetic modification, allowing them to be readily available for patients to start treatment soon after they are identified as a therapy appropriate for a given patient. Furthermore, some patients may be able to receive this type of treatment in an outpatient setting depending on the characteristics of the treating center, the patient’s health, and the safety profile of a given bispecific antibody.

How can people with relapsed or refractory NHL work closely with their care team to determine the treatment option that is best suited for their individual needs?

Patients with R/R NHL who have been through previous treatments should be central in the treatment decision-making process with their hematologist/oncologist. A variety of treatment options are available to patients, and it is crucial that patients have a say in their treatment journey to prioritize what’s most important to them. It’s critical for patients to know all their treatment options and be made aware of the risks and benefits of each. They should understand the efficacy and side effects of different treatments, how those treatments are given, including the logistics and frequency of treatment, and any other impact a therapy might have on them.

Members of the patient’s clinical team should ask patients questions to help the care team understand the patient’s treatment preferences. For example: What are the patient’s priorities for length of treatment? Is time off treatment important to them? How far is it feasible for them to travel for treatment? Do they have a preference for a community or academic setting for treatment? Do they have a preference for the type of therapy they receive when there are multiple treatment options that might be appropriate?

Because this can be a lot of information for patients to process, it could be helpful for patients to ask a loved one or trusted friend to come to the appointment to help the patient remember the details of the discussion. It is critical to empower patients to express their opinions and have an open dialogue about the patient’s preferences and priorities. With this approach, patients can work with their care team to select the treatment that is best suited to their individual needs.

The contents and information in this Genentech-sponsored article are for informational purposes only and not intended as a substitute for professional medical advice. If you think you may have a medical emergency, dial 9-1-1 or contact your doctor immediately.