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Greve P, Meyer-Wentrup FAG, Peperzak V, Boes M. Upcoming immunotherapeutic combinations for B-cell lymphoma. IMMUNOTHERAPY ADVANCES 2021; 1:ltab001. [PMID: 35919738 PMCID: PMC9326875 DOI: 10.1093/immadv/ltab001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/11/2020] [Accepted: 01/09/2021] [Indexed: 11/13/2022] Open
Abstract
After initial introduction for B-cell lymphomas as adjuvant therapies to established cancer treatments, immune checkpoint inhibitors and other immunotherapies are now integrated in mainstream regimens, both in adult and pediatric patients. We here provide an overview of the current status of combination therapies for B-cell lymphoma, by in-depth analysis of combination therapy trials registered between 2015–2020. Our analysis provides new insight into the rapid evolution in lymphoma treatment, as propelled by new additions to the treatment arsenal. We conclude with prospects on upcoming clinical trials which will likely use systematic testing approaches of more combinations of established chemotherapy regimens with new agents, as well as new combinations of immunotherapy and targeted therapy. Future trials will be set up as basket or umbrella-type trials to facilitate the evaluation of new drugs targeting specific genetic changes in the tumor or associated immune microenvironment. As such, lymphoma patients will benefit by receiving more tailored treatment that is based on synergistic effects of chemotherapy combined with new agents targeting specific aspects of tumor biology and the immune system.
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Affiliation(s)
- Patrick Greve
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Hematology-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Victor Peperzak
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne Boes
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Lymphoid malignancies typically promote an infiltrate of immune cells at sites involved by the disease. While some of the immune cells present in lymphoma have effector function, the immune system is unable to eradicate the malignant clone. Therapies that optimize immune function therefore have the potential to improve the outcome of lymphoma patients. In this Review, we discuss immunologic approaches that directly target the malignant cell as well as approaches to optimize both the innate and adaptive immune response to the tumor. While many of these therapies have shown single-agent activity, the future will clearly require thoughtful combinations of these approaches.
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Tomuleasa C, Iluta S, Pasca S, Roman A, Piciu D, Jitaru C, Teodorescu P, Rus I, Bojan A, Dima D, Zdrenghea M, Petrushev B. Complete metabolic remission in an 84-year old patient with relapsed/refractory diffuse large B-cell lymphoma following combination immunotherapy with lenalidomide plus rituximab. Int J Hematol 2020; 112:597-598. [PMID: 32886277 DOI: 10.1007/s12185-020-02989-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/27/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Ciprian Tomuleasa
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania. .,Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Gheorghe Marinescu Street, 400124, Cluj-Napoca, Romania.
| | - Sabina Iluta
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania.,Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Gheorghe Marinescu Street, 400124, Cluj-Napoca, Romania
| | - Sergiu Pasca
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Andrei Roman
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca, Cluj-Napoca, Romania.,Department of Radiology,, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Doina Piciu
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca, Cluj-Napoca, Romania.,Department of Radiology,, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Ciprian Jitaru
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Patric Teodorescu
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania.,Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Gheorghe Marinescu Street, 400124, Cluj-Napoca, Romania
| | - Ioana Rus
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania.,Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Gheorghe Marinescu Street, 400124, Cluj-Napoca, Romania
| | - Anca Bojan
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania.,Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Gheorghe Marinescu Street, 400124, Cluj-Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Mihnea Zdrenghea
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania.,Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Gheorghe Marinescu Street, 400124, Cluj-Napoca, Romania
| | - Bobe Petrushev
- Medfuture Research Center, Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca, Cluj-Napoca, Romania
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Abstract
Lenalidomide (Revlimid®) is a targeted immunomodulatory drug with multiple mechanisms of action. In the USA and the EU, oral lenalidomide is indicated in combination with rituximab or a rituximab product for the treatment of patients with previously treated follicular lymphoma. In the pivotal, phase III AUGMENT trial, lenalidomide + rituximab significantly prolonged progression-free survival (PFS; primary endpoint) relative to placebo + rituximab in patients with relapsed or refractory indolent non-Hodgkin lymphoma, with the PFS benefit appearing to be specific to patients with follicular lymphoma and extending to elderly patients with this subtype. Lenalidomide + rituximab also demonstrated activity in an interim analysis of the phase III MAGNIFY trial in patients with relapsed or refractory indolent non-Hodgkin lymphoma, including those with rituximab-refractory disease. Lenalidomide had an acceptable tolerability profile. Although grade 3 or 4 neutropenia occurred more frequently with lenalidomide + rituximab than with placebo + rituximab, this was generally well managed with dosage adjustments and growth factor support. In conclusion, lenalidomide in combination with rituximab represents an important new treatment option for previously treated follicular lymphoma, including patients whose disease has become refractory to rituximab.
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Affiliation(s)
- Hannah A Blair
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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