68IN - Targeted therapy in malignant lymphoma: Clinical implications and perspectives

Date 30 September 2012
Event ESMO Congress 2012
Session Molecular targets in malignant lymphomas: From basic science to clinical practice
Topics Anti-Cancer Agents & Biologic Therapy
Lymphomas
Presenter Michele Ghielmini
Authors M. Ghielmini
  • Medical Oncology, IOSI Istituto Oncologico Svizzera Italiana Ospedale Regionale Bellinzona e Valli, 6500 - Bellinzona/CH

Abstract

With a whole range of new drugs showing activity in different types of lymphoma, we question if any of these will make the new step forward as it has been the case with the introduction of doxorubicin, high-dose chemotherapy or rituximab. If we look at some most significant diseases, we can hope that for Hodgkin's lymphoma (HL) the advent of active drugs as brentixumab vedotin and panobinostat could make chemotherapy more effective, reducing the number of cycles needed or allowing the avoidance of drugs with long-term side effects. In the treatment of diffuse large B-cell lymphoma (DLBCL) what is needed is a drug improving on the cure rate. The new available substances have not yet shown to be so promising but not all of them have yet been combined with classical chemotherapy. Follicular lymphoma (FL) is a well controllable disease but we want a drug which will render this disease curable; in the meanwhile we hope that patient-friendly treatments will allow long-term maintenance and disease control. The combination of lenalidomide with rituximab, but also the new CAL 101, BTK inhibitors or inotuzumab ozogamicin could increase the possibility of prolonging the time without symptoms of disease or treatment. The impact of these drugs on survival though will be long to ascertain in such an indolent disease. Mantle cell lymphoma (MCL) remains rapidly progressing and difficult to treat. It is considered not curable and it will therefore be important ascertain the impact of bortezomib, temsirolimus, BTK and PI3K inhibitors or blinotumumab combined with standard treatment on survival or cure. Finally, peripheral T-cell lymphoma (PTCL) is an orphan disease compared to the B-cell lymphomas as it could not take advantage of the introduction of rituximab. In anaplastic large cell lymphoma (ALCL) brentuximab vedotin has shown very important activity and might make the difference, while the addition of pralatrexate, romidepsin or vorinostat could change the prognosis of the other entities. Despite many of these drugs having shown promising data, the challenge is now to combine them with standard treatment in order to obtain regimens which are more active but not more toxic. Phase II trials are ongoing to develop the optimal combination schedules.

Disclosure

M. Ghielmini: Member of advisory board for Roche, Lilly, BMS, Celgene, Pfizer, Jansen