Elizabeth M. Adler, author of "Living with Lymphoma: A Patient's Guide" talks about her diagnosis and exciting new developments in lymphoma therapies.
I almost died 19 years ago. After an uneasy year during which my weight plummeted, as I became more and more tired, anemic and short of breath, I became concerned that I might have TB and asked my doctor for a chest x-ray. Fortunately, he humored that request: the x-ray disclosed a tumor crushing one of my lungs and, in the fall of 1996, I was diagnosed with an aggressive form of non-Hodgkin lymphoma (NHL). One of the first things I did following my diagnosis was to get on the Internet to see what I could learn about my prognosis. I was in poor shape by then, with a tumor the size of a football, and the statistics I turned up were grim. It looked like my luck had pretty much run out.
What I didn’t know was that lymphoma therapy was about to undergo a sea change leading to dramatic improvements in patient survival. This transformation of lymphoma treatment involved the adoption of a new kind of therapy, the monoclonal antibody Rituxan. At the time of my diagnosis, clinical trials had already begun to show that Rituxan, which specifically recognizes and targets B cells — the cells that give rise to B-cell lymphomas — was effective against slowly progressing forms of lymphoma. When given as a solo agent, Rituxan did not appear to be very effective against aggressive lymphomas (like mine); however, I stumbled into a trial that combined Rituxan with standard chemotherapy to treat people with aggressive disease.
My luck had turned: the results of the clinical trials involving Rituxan were astonishing and, in 1997, Rituxan became the first monoclonal antibody approved by the FDA to treat cancer. Initially approved to treat certain types of B-cell lymphoma only after the disease had relapsed following standard chemotherapy, or failed to respond to it, Rituxan is now included in the therapy of most people with B-cell lymphomas (about 85% of NHL in the United States).
Like 1997, 2015 was an exciting year for people with lymphoma: the American Society of Clinical Oncology (ASCO) named the “transformation of treatment for chronic lymphocytic leukemia” as the “Cancer Advance of the Year.” Two of these transformative therapies involve the use of monoclonal antibodies (combined with chemotherapy). Like Rituxan, the monoclonal antibodies Gazyva and Arzerra can act as immunotherapies to recruit your own immune system to destroy the malignant cells (independent of any direct effects they may have on the targeted cells). Both Gazyva and Arzerra target CD20, the same B cell protein that Rituxan recognizes, but they have been tweaked to modify the ways in which they interact with the immune system and the malignant cells.
The other two transformative therapies, Imbruvica and Zydelig, are drugs. They differ from classical forms of chemotherapy in being more selectively targeted against the malignant cells. The development of Imbruvica and Zydelig as targeted therapies built upon years of research that provided detailed insight into the intracellular signals that enable B cells to survive and proliferate and the identification of specific proteins whose function could be inhibited to block those signals.
As our understanding of immunology — and lymphoma cell biology — continues to grow, we can look forward to the development of ever more selective, ever more effective lymphoma therapies in 2016 and the years to come.