Non-Hodgkin Lymphoma: Targeted Therapy
What is targeted therapy?
Targeted therapy uses medicines that attack certain parts of cancer cells. These medicines
target proteins or cell functions that help cancer cells stay alive, grow, and divide.
They're different from chemotherapy (chemo) medicines. And they may work when chemo
does not. Targeted therapy focuses on cancer cells. They mostly leave healthy cells
alone. So the side effects are different and often less severe than chemo side effects.
When is targeted therapy used for non-Hodgkin lymphoma?
Targeted medicines can be used to treat some types of non-Hodgkin lymphoma. They tend
to be used after other treatments have been tried. But some targeted therapies are
used earlier. Targeted therapy is often given along with chemotherapy.
Your lymphoma cells will be tested to look for changes in the cells that can be matched
with a medicine that targets those changes.
Which targeted therapy medicines are used to treat non-Hodgkin lymphoma?
The targeted medicines used to treat non-Hodgkin lymphoma include:
Kinase inhibitors
Kinases are proteins in cells that help send signals to the control center inside
the cell. Some kinases help lymphoma cells grow or stay alive. Medicines that block
kinases are called kinase inhibitors. They can help slow or stop the growth of some
types of non-Hodgkin lymphoma cells. They are grouped by the specific kinase they
work on:
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BTK inhibitors. These medicines block the BTK protein, which helps lymphoma cells grow and stay alive.
They tend to be used after at least one other treatment has been tried. They are taken
daily as a pill. Side effects can include headache, easy bruising, infection, changes
in bowel movements, and heart rhythm problems.
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PI3K inhibitors. These medicines work on a group of kinases known as PI3K. PI3K kinases send signals
that affect cell growth. These medicines are taken as pills or given as infusions
into a vein through an IV. They're most often used when other lymphoma treatments
stop working. Common side effects include fever, feeling tired, nausea, diarrhea,
cough, belly pain, rash, and low blood cell counts.
Proteasome inhibitors
Proteasomes act like tiny garbage disposal units inside cells. They get rid of proteins
the cell doesn't need. This helps control cell growth. Proteasome inhibitors stop
proteasomes so they don't destroy proteins. As the proteins build up inside the lymphoma
cells, they die.
Bortezomib is a proteasome inhibitor that can be used to treat some types of lymphoma.
It tends to be used if other treatments don't work. It can be given through an IV
(intravenous line) into a vein or as a shot under the skin (subcutaneous injection).
Side effects include nausea, appetite loss, and low blood cell counts. It can also
cause nerve damage. This can lead to numbness, tingling, or pain in the hands and
feet.
HDAC inhibitors
HDAC (histone deacetylase) inhibitors work on histones. These are proteins that affect
the genes in cells that control cell growth. HDAC inhibitors can be used to treat
some types of T-cell lymphomas, including skin lymphomas.
Examples of these medicines are romidepsin and belinostat. Both are given through
an IV into your blood. Side effects can include nausea, vomiting, shortness of breath,
feeling tired, and low blood cell counts.
EZH2 inhibitors
EZH2 is a protein that can help some cancer cells grow. Some people with follicular
lymphoma (FL) have an EZH2 gene mutation in their cancer cells. A medicine called
tazemetostat targets this mutation to kill the FL cells. It may be tried if other
treatments don't work. Sometimes it is even used to treat FL cells that don't have
the EZH2 mutation when there aren't other good treatment options left. It is taken
as a pill.
Common side effects include feeling tired, low blood cell counts, bone and muscle
pain, and nausea.
Nuclear export inhibitors
The nucleus is the "brain" of the cell. It controls the proteins that keep a cell
alive. A protein called XPO1 helps move proteins from the nucleus to other parts of
the cell to keep it working and alive. Selinexor is a medicine called a nuclear export
inhibitor. It blocks the XPO1 protein so other proteins cannot be moved out of the
nucleus. It might be used to treat certain B-cell lymphomas that are no longer responding
to any other treatments.
This medicine is taken as a pill. Common side effects include low blood cell counts,
which can cause easy bleeding, tiredness, and shortness of breath. It can also cause
nausea, diarrhea, weight loss, and low sodium levels in your blood.
Working with your healthcare provider
Talk with your healthcare providers about what you should expect targeted therapy
to be like and what side effects you should watch for. Be sure you know when to call
them. For instance, if your blood counts drop, it can make you more likely to get
infections. You may be told to check your temperature and stay away from people who
are sick. You may need to call if you have a fever or chills. Make sure you know what
number to call with problems or questions. Ask how to get help after hours and on
weekends and holidays.