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Published on: October 19, 2014
Novel targeted drugs for follicular and marginal zone lymphoma: a comprehensive review
Andrea Rivero1,2, Pablo Mozas1,2, Laura Magnano1,2
1Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.
Abstract:
Although mostly incurable, indolent non-Hodgkin lymphomas (iNHL) are chronic diseases with a median overall survival approaching 20 years. In recent years, important advances in the knowledge of the biology of these lymphomas have led to the development of new drugs, mostly chemotherapy-free, with promising outcomes. With a median age of around 70 years at diagnosis, many patients with iNHL suffer from comorbid conditions that may limit treatment options. Therefore, nowadays, in the transition towards personalized medicine, several challenges lie ahead, such as identifying predictive markers for the selection of treatment, the adequate sequencing of available therapies, and the management of new and accumulated toxicities. In this review, we include a perspective on recent therapeutic advances in follicular and marginal zone lymphoma. We describe emerging data on approved and emerging novel therapies, such as targeted therapies (PI3K inhibitors, BTK inhibitors, EZH2 inhibitors), monoclonal antibodies and antibody-drug conjugates. Finally, we describe immune-directed approaches such as combinations with lenalidomide or the even more innovative bispecific T-cell engagers and chimeric antigen receptor T-cell therapy, which can achieve a high rate of durable responses with manageable toxicities, further obviating the need for chemotherapy.
Insights
New indolent non-Hodgkin lymphoma (iNHL) therapies, including targeted drugs and immunotherapy, offer promising outcomes. These chemotherapy-free options are crucial for older patients with comorbidities, advancing personalized medicine in iNHL treatment.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Indolent non-Hodgkin lymphomas (iNHL) are chronic conditions with long survival but limited curative options.
- Patients often have comorbidities, complicating treatment decisions.
- Advances in understanding iNHL biology have spurred the development of novel, often chemotherapy-free, therapies.
Purpose of the Study:
- To review recent therapeutic advances in follicular and marginal zone lymphoma.
- To discuss emerging targeted therapies, monoclonal antibodies, and antibody-drug conjugates.
- To explore immune-directed approaches like bispecific T-cell engagers and CAR T-cell therapy.
Main Methods:
- Review of recent literature on iNHL therapeutics.
- Analysis of emerging data on novel drug classes.
- Perspective on personalized medicine challenges and future directions.
Main Results:
- Novel therapies include PI3K inhibitors, BTK inhibitors, EZH2 inhibitors, and antibody-drug conjugates.
- Immune-directed approaches such as lenalidomide combinations, bispecific T-cell engagers, and CAR T-cell therapy show significant promise.
- These newer treatments can achieve durable responses with manageable toxicities, reducing reliance on chemotherapy.
Conclusions:
- Significant progress has been made in developing chemotherapy-free treatments for iNHL.
- Personalized medicine approaches are essential for optimizing treatment selection and sequencing.
- Novel targeted and immune-based therapies offer improved outcomes and tolerability for iNHL patients.
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