New Hope for Aggressive Lymphoma Patients

An innovative cancer treatment is showing promise for patients with aggressive B-cell lymphoma, according to researchers. This new approach, which avoids traditional chemotherapy, targets multiple molecular pathways that large B-cell lymphoma (DLBCL) tumors depend on for survival. DLBCL, the most prevalent form of lymphoma, affects the B-cells of the immune system.

The clinical trial, spearheaded by the National Institutes of Health, enrolled 50 DLBCL patients with poor prognoses. These patients had either relapsed after periods of remission or their cancers had become resistant to existing treatments.

Dr. Christopher Melani from the National Cancer Institute's Center for Cancer Research, co-led the study. He noted, "Many of these patients who stopped responding to standard treatments would have otherwise died within a year, and now we have a good proportion who are still alive past two years, and some past four years."

The experimental treatment, dubbed ViPOR, is a five-drug combination consisting of venetoclax, ibrutinib, prednisone, obinutuzumab, and lenalidomide. Administered in two-week cycles with a one-week break, the regimen has shown significant promise. Tumors shrank in approximately 54% of the 48 patients evaluated, with 38% achieving complete remission, meaning their tumors disappeared entirely.

At the two-year mark, 36% of all patients were still alive, and 34% remained disease-free. Notably, the treatment was particularly effective for two specific cancer subtypes. Complete responses were observed in 62% of patients with non-GCB DLBCL and 53% of those with high-grade B-cell lymphoma double-hit. These subtypes showed higher overall survival rates and longer periods without tumor progression compared to other participants. Researchers believe this is because these cancers rely heavily on the survival mechanisms that ViPOR targets.

Interestingly, ViPOR also benefited 30% of patients whose lymphomas had not responded to or had returned after CAR T-cell therapy. This therapy, which uses a patient's own T-cells to attack cancer cells, is currently the standard care for relapsed DLBCL.

The side effects of ViPOR were generally mild to moderate compared to standard treatments. Researchers are considering the addition of more drugs to the regimen and are investigating its effectiveness in other resistant lymphoma types. They are planning a larger phase 2 study to validate these findings.

Further studies are needed to develop effective treatments for GCB DLBCL subtypes that were less responsive to ViPOR. These findings, published on June 20 in the New England Journal of Medicine, point towards a new direction in lymphoma treatment, offering hope to patients with few other options.