Examining the Non-Hodgkin Lymphoma Treatment Paradigm

In season 3, episode 6 of Targeted Talks, Yazan Samhouri, MD, a hematologist/oncologist in the Division of Hematology and Cellular Therapy at West Penn Hospital and Alleghany General Hospital, discusses the exciting new agents for the treatment of non-Hodgkin lymphoma, the clinical trials that support their use, and hopes for the future of treatment.

In the past 5 years, many treatment advances have been introduced in the non-Hodgkin lymphoma paradigm. Agents that made the biggest impact include antibody-drug conjugates like bretuximab vedotin (Adcetris) and polatuzumab vedotin (Polivy), as well as chimeric antigen receptor (CAR) T-cell therapies like axicabtagene ciloleucel (Yescarta) and tisagenlecleucel (Kymriah).

According to Samhouri, these targeted therapies have revolutionized the field. Although, chemotherapy and other traditional therapies still have a place in the treatment paradigm, the introduction of newer agents has made targeted therapy the optimal choice compared with chemotherapy for patients with relapsed disease. Moreover, these agents continue to move up in the sequence of treatment. Notably, some targeted therapies are now being administered in the front-line setting.

“There is a role for all the traditional therapies. We have many options to choose from now, including the traditional therapies, which is a good problem to have. But there is a shift in the last 5 years toward more targeted therapy and adaptive cell therapy,” Samhouri said during the podcast interview.

Looking ahead, Samhouri explains that in T-cell lymphomas, there remains a need for better therapies that can improve survival. In the B-cell lymphoma space, there are a lot of therapies being investigated, but in the relapsed setting, treatment continues to be a challenge for physicians. Results from CAR T-cell therapy and other targeted therapy clinical trials are pending, which may offer solutions to ongoing challenges in the B-cell lymphoma landscape.

“Every year and every month, we are understanding the pathophysiology and the genetics of the of different subtypes of non-Hodgkin lymphoma. This will lead for us to better understand which treatment we will choose for each patient. It's not a one size fits all anymore,” Samhouri states.

Another hope for the future of treatment for patients with non-Hodgkin lymphoma is improving the durability of responses. Samhouri says that durable responses are essential for limiting the need for transplant, which is an intensive and toxic treatment.