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Visweshwar N, Rico JF, Killeen R, Manoharan A. Harnessing the Immune System: An Effective Way to Manage Diffuse Large B-Cell Lymphoma. J Hematol 2023; 12:145-160. [PMID: 37692863 PMCID: PMC10482611 DOI: 10.14740/jh1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/01/2023] [Indexed: 09/12/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a heterogenous hematological disorder with malignant potential controlled by immunological characteristics of the tumor microenvironment. Rapid breakthrough in the molecular pathways has made immunological approaches the main anchor in the management of DLBCL, with or without chemotherapeutic agents. Rituximab was the first monoclonal antibody approved for the treatment of DLBCL. Following rituximab that transformed the therapeutic landscape, other novel immunological agents including chimeric antigen T-cell therapy have reshaped the management of relapsed/refractory DLBCL. However, resistance and refractory state remain a challenge in the management of DLBCL. For this literature review, we screened articles from Medline, Embase, Cochrane databases and the European/North American guidelines from March 2010 through October 2022 for DLBCL. Here we discuss immunological agents that will significantly affect future treatment of this aggressive type of lymphoma.
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Affiliation(s)
- Nathan Visweshwar
- Department of Hematology, University of South Florida, Tampa, FL, USA
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Robert Killeen
- Department of Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Arumugam Manoharan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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2
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Papageorgiou SG, Thomopoulos TP, Liaskas A, Vassilakopoulos TP. Monoclonal Antibodies in the Treatment of Diffuse Large B-Cell Lymphoma: Moving beyond Rituximab. Cancers (Basel) 2022; 14:1917. [PMID: 35454825 PMCID: PMC9026383 DOI: 10.3390/cancers14081917] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
Although rituximab has revolutionized the treatment of diffuse large B-cell lymphoma (DLBCL), a significant proportion of patients experience refractory disease or relapse early after the end of treatment. The lack of effective treatment options in the relapsed/refractory (R/R) setting had made the prognosis of these patients dismal. The initial enthusiasm for novel anti-CD20 antibodies had been short-lived as they failed to prove their superiority to rituximab. Therefore, research has focused on developing novel agents with a unique mechanism of action. Among them, two antibody-drug conjugates, namely polatuzumab vedotin (PolaV) and loncastuximab tesirine, along with tafasitamab, an anti-CD19 bioengineered antibody, have been approved for the treatment of R/R DLBCL. Whereas PolaV has been FDA and EMA approved, EMA has not approved loncastuximab tesirine and tafasitamab yet. Results from randomized trials, as well as real-life data for PolaV have been promising. Novel agents as bispecific antibodies bridging CD3 on T-cells to CD20 have shown very promising results in clinical trials and are expected to gain approval for treatment of R/R DLBCL soon. As the therapeutic armamentarium against DLBCL is expanding, an improvement in survival of patients with R/R and higher cure rates might soon become evident.
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Affiliation(s)
- Sotirios G. Papageorgiou
- Hematology Unit, Second Propaedeutic Department of Internal Medicine and Research Institute, School of Medicine, National and Kapodistrian University of Athens, University General Hospital “Attikon”, 18120 Athens, Greece; (S.G.P.); (T.P.T.)
| | - Thomas P. Thomopoulos
- Hematology Unit, Second Propaedeutic Department of Internal Medicine and Research Institute, School of Medicine, National and Kapodistrian University of Athens, University General Hospital “Attikon”, 18120 Athens, Greece; (S.G.P.); (T.P.T.)
| | - Athanasios Liaskas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece;
| | - Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece;
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3
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Paszkiewicz-Kozik E, Michalski W, Taszner M, Mordak-Domagała M, Romejko-Jarosińska J, Knopińska-Posłuszny W, Najda J, Borawska A, Chełstowska M, Świerkowska M, Dąbrowska-Iwanicka A, Malenda A, Druzd-Sitek A, Konecki R, Kumiega B, Osowiecki M, Ostrowska B, Szpila T, Szymański M, Targoński Ł, Domańska-Czyż K, Popławska L, Giebel S, Lange A, Pluta A, Zaucha JM, Rymkiewicz G, Walewski J. Ofatumumab with iphosphamide, etoposide and cytarabine for patients with transplantation-ineligible relapsed and refractory diffuse large B-cell lymphoma. Br J Haematol 2022; 198:73-81. [PMID: 35362096 PMCID: PMC9322457 DOI: 10.1111/bjh.18166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
The efficacy of salvage treatment of diffuse large B-cell lymphoma (DLBCL) patients who relapse or progress (rrDLBCL) after initial therapy is limited. Efficacy and safety of ofatumumab with iphosphamide, etoposide and cytarabine (O-IVAC) was evaluated in a single-arm study. Dosing was modified for elderly patients. Patients received up to six cycles of treatment. The primary end-point was the overall response rate (ORR). Patients were evaluated every two cycles and then six and 12 months after treatment. Other end-points included progression-free survival (PFS), event-free survival (EFS), overall survival (OS) and safety. Seventy-seven patients received salvage treatment with O-IVAC. The average age was 56.8 years; 39% had an Eastern Cooperative Oncology Group (ECOG) performance status of at least 3; 78% had disease of Ann Arbor stage 3 or 4; 58% received one or more prior salvage therapies. The ORR for O-IVAC was 54.5%. The median duration of study follow-up was 70 months. The median PFS and EFS were 16.3 months each. The median OS was 22.7 months. Age, ECOG performance status and the number of prior therapy lines were independent predictors of survival. Treatment-related mortality was 15.5%. O-IVAC showed a high response rate in a difficult-to-treat population and is an attractive treatment to bridge to potentially curative therapies.
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Affiliation(s)
| | - Wojciech Michalski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Monika Mordak-Domagała
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
| | | | - Wanda Knopińska-Posłuszny
- Maritime Hospital, Gdynia, Poland.,Warmian-Masurian Cancer Center of the Ministry of the Interior and Administration's Hospital, Olsztyn, Poland
| | - Jacek Najda
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Anna Borawska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Monika Świerkowska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Agata Malenda
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Robert Konecki
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Kumiega
- Sniadecki Memorial Specialist Hospital, Nowy Sacz, Poland
| | - Michał Osowiecki
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Ostrowska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Szpila
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Marcin Szymański
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Łukasz Targoński
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Lidia Popławska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Sebastian Giebel
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Andrzej Lange
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
| | - Andrzej Pluta
- Department of Hematology, Brzozow Oncology Center, Brzozow, Poland
| | - Jan Maciej Zaucha
- Medical University of Gdansk, Gdansk, Poland.,Maritime Hospital, Gdynia, Poland
| | - Grzegorz Rymkiewicz
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jan Walewski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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4
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Pan J, Ghimire S, Alpdogan SO, Chapman A, Carabasi M, DiMeglio M, Gong J, Martinez-Outschoorn U, Rose L, Ramirez M, Wagner JL, Weiss M, Flomenberg N, Pro B, Porcu P, Filicko-OHara J, Gaballa S. Phase I/II study of bendamustine in combination with ofatumumab, carboplatin, etoposide (BOCE) for relapsed or refractory aggressive B-cell non-Hodgkin lymphoma. Leuk Lymphoma 2020; 62:590-597. [PMID: 33146052 DOI: 10.1080/10428194.2020.1842400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We developed an outpatient salvage chemotherapy regimen using bendamustine, ofatumumab, carboplatin and etoposide (BOCE) to treat relapsed/refractory non-Hodgkin lymphoma (RR NHL) in a single-center phase I/II study. Primary objectives were safety, tolerability and overall response rate (ORR). Thirty-five RR NHL patients (57% de novo large cell [DLBCL] or grade 3B follicular [FL], 26% transformed DLBCL, 9% grade 3A FL, 3% mantle cell; median age = 62, median prior therapies = 1) were treated. Median follow-up was 24.1 months. ORR was 69% (CR = 49%, PR = 20% [ORR = 70%, CR = 50%, PR = 20% in the de novo DLBCL/grade 3B FL subgroup]). Median progression-free survival was 5.1 months and overall-survival 26.2 months. Twelve patients subsequently underwent stem cell transplantation. The most common non-hematologic grade 3-4 toxicities were neutropenic fever and hypophosphatemia. There were no treatment-related deaths. In conclusion, BOCE is a safe and effective outpatient salvage regimen for patients with RR NHL and serves as an effective bridge to stem cell transplantation.
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Affiliation(s)
- Jonathan Pan
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sushil Ghimire
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - S Onder Alpdogan
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Andrew Chapman
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Matthew Carabasi
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Martina DiMeglio
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jerald Gong
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Lewis Rose
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael Ramirez
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John L Wagner
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark Weiss
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Neal Flomenberg
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Barbara Pro
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pierluigi Porcu
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Joanne Filicko-OHara
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sameh Gaballa
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Division of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
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5
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Torka P, Barth M, Ferdman R, Hernandez-Ilizaliturri FJ. Mechanisms of Resistance to Monoclonal Antibodies (mAbs) in Lymphoid Malignancies. Curr Hematol Malig Rep 2020; 14:426-438. [PMID: 31559580 DOI: 10.1007/s11899-019-00542-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Passive immunotherapy with therapeutic monoclonal antibodies (mAbs) has revolutionized the treatment of cancer, especially hematological malignancies over the last 20 years. While use of mAbs has improved outcomes, development of resistance is inevitable in most cases, hindering the long-term survival of cancer patients. This review focuses on the available data on mechanisms of resistance to rituximab and includes some additional information for other mAbs currently in use in hematological malignancies. RECENT FINDINGS Mechanisms of resistance have been identified that target all described mechanisms of mAb activity including altered antigen expression or binding, impaired complement-mediated cytotoxicity (CMC) or antibody-dependent cellular cytotoxicity (ADCC), altered intracellular signaling effects, and inhibition of direct induction of cell death. Numerous approaches to circumvent identified mechanisms of resistance continue to be investigated, but a thorough understanding of which resistance mechanisms are most clinically relevant is still elusive. In recent years, a deeper understanding of the tumor microenvironment and targeting the apoptotic pathway has led to promising breakthroughs. Resistance may be driven by unique patient-, disease-, and antibody-related factors. Understanding the mechanisms of resistance to mAbs will guide the development of strategies to overcome resistance and re-sensitize cancer cells to these biological agents.
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MESH Headings
- Animals
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antigens, Neoplasm/immunology
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Apoptosis
- Complement System Proteins/immunology
- Drug Resistance, Neoplasm/genetics
- Humans
- Leukemia, Lymphoid/drug therapy
- Leukemia, Lymphoid/etiology
- Leukemia, Lymphoid/metabolism
- Leukemia, Lymphoid/pathology
- Lymphoma/drug therapy
- Lymphoma/etiology
- Lymphoma/metabolism
- Lymphoma/pathology
- Polymorphism, Genetic
- Receptors, IgG/metabolism
- Risk Factors
- Treatment Outcome
- Tumor Microenvironment
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Affiliation(s)
- Pallawi Torka
- Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Mathew Barth
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Robert Ferdman
- Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Francisco J Hernandez-Ilizaliturri
- Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
- Department of Medicine, Jacob's School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA.
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6
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Flinn IW, Erter J, Daniel DB, Mace JR, Berdeja JG. Phase II Study of Bendamustine and Ofatumumab in Elderly Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma Who Are Poor Candidates for R-CHOP Chemotherapy. Oncologist 2019; 24:1035-e623. [PMID: 31073022 PMCID: PMC6693706 DOI: 10.1634/theoncologist.2019-0286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/06/2019] [Indexed: 11/17/2022] Open
Abstract
Lessons Learned. The combination of ofatumumab and bendamustine in elderly patients with diffuse large B‐cell lymphoma demonstrated modest efficacy compared with standard of care. The poor response may have been due to patient age and the high rate of treatment discontinuation.
Background. This phase II trial evaluated the efficacy of bendamustine and ofatumumab in elderly patients with newly diagnosed diffuse large B‐cell lymphoma (DLBCL) who were not candidates for rituximab cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP). Methods. Patients received IV 90 mg/m2 bendamustine on days 1 and 2 of cycles 1 through 6 and IV 1,000 mg ofatumumab on days 1 and 8 of cycle 1 and on day 1 of cycles 2 through 6. Both drugs were administered at the U.S. Food and Drug Administration‐approved dose for combination therapy. All patients received premedications before each infusion of ofatumumab and hematopoietic growth factors. Treatment was administered in 21‐day cycles, with restaging after cycle 3 and cycle 6. The primary endpoint was complete response rate (CRR). Results. Twelve of 21 enrolled patients completed treatment; median age was 83 years. The most common reasons for treatment discontinuation were disease progression (three patients), intercurrent illness (two patients), and death (one patient due to drug‐related sepsis and bowel necrosis and one patient due to unknown cause). Thrombocytopenia (14%), neutropenia (10%), diarrhea (10%), vomiting (10%), and dehydration (10%) were the most common grade ≥3 treatment‐related adverse events. The overall response rate was 90.5% and the CRR was 33.3%. Median progression‐free survival (PFS) and overall survival (OS) were 8.6 and 12.0 months, respectively. Conclusion. The combination of ofatumumab and bendamustine is feasible in elderly patients with DLBCL.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/standards
- Bendamustine Hydrochloride/administration & dosage
- Bendamustine Hydrochloride/adverse effects
- Cyclophosphamide/adverse effects
- Disease Progression
- Disease-Free Survival
- Doxorubicin/adverse effects
- Drug Administration Schedule
- Feasibility Studies
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Male
- Prednisone/adverse effects
- Rituximab/adverse effects
- Standard of Care
- Vincristine/adverse effects
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Affiliation(s)
- Ian W Flinn
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennesse, USA
| | - Jack Erter
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennesse, USA
| | - Davey B Daniel
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennesse, USA
| | - Joseph R Mace
- Florida Cancer Specialists, St. Petersburg, Florida, USA
| | - Jesus G Berdeja
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennesse, USA
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Salles GA, Pettengell R, Cordoba R, Długosz-Danecka M, Jurczak W, Tilly H. Treatment of aggressive B-cell non-Hodgkin lymphoma beyond frontline therapy in patients not eligible for stem cell transplantation: a structured review. Leuk Lymphoma 2019; 60:1610-1625. [PMID: 30702000 DOI: 10.1080/10428194.2018.1564828] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aggressive B-cell non-Hodgkin lymphoma (aNHL) accounts for ∼50% of all NHL cases. The only potentially curative, broadly available treatment for patients with relapse, failing frontline treatment, is high-dose therapy followed by autologous stem cell transplantation (ASCT); patients ineligible for/who have failed ASCT have limited standard-of-care options. We conducted a structured review of treatments for relapsed/refractory patients with aNHL based on literature published between 2006 and 2017. Of the 22 publications identified for inclusion, most described phase II, single-arm trials (N = 25-217), and only three were randomized studies (phase II [N = 96], phase II/III [N = 111] and phase III [N = 338]). The majority of treatments evaluated resulted in only modest efficacy (median progression-free survival, 2.1-20.0 months) and ultimately poor health outcomes (median overall survival, 25 weeks-15.5 months). In conclusion, there is an unmet need for novel, effective, and tolerable treatments for patients with relapsed/refractory aNHL who are ineligible for/have failed ASCT.
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Affiliation(s)
- Gilles A Salles
- a Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Hématologie, Université Lyon-1 , Lyon , France
| | | | - Raul Cordoba
- c Lymphoma Unit , Fundación Jiménez Díaz University Hospital , Madrid , Spain
| | | | - Wojciech Jurczak
- d Department of Hematology , Jagiellonian University , Kraków , Poland
| | - Hervé Tilly
- e Department of Haematology , Université de Rouen , Rouen , France
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8
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Barth MJ, Minard-Colin V. Novel targeted therapeutic agents for the treatment of childhood, adolescent and young adult non-Hodgkin lymphoma. Br J Haematol 2019; 185:1111-1124. [PMID: 30701541 DOI: 10.1111/bjh.15783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/29/2018] [Indexed: 02/06/2023]
Abstract
Non-Hodgkin lymphomas (NHLs) are a heterogeneous group of malignancies. Most NHLs in children, adolescent and young adult patients are aggressive lymphomas that are generally treated with multi-agent chemotherapy or immunochemotherapy regimens. While overall survival is high, the treatment can lead to a high rate of acute and long-term toxicity. However, in the rarer instance of relapsed or refractory disease, outcomes are dismal. Novel therapeutic approaches to the treatment of both T-cell and B-cell NHLs are critical to improve outcomes while also minimising the associated toxicity of current treatment regimes. Potential therapeutic approaches in development include humoral and cellular immunotherapies, small molecule inhibitors of relevant signalling pathways and epigenetic modifying agents. In this review, we will highlight the current state of development of agents of interest with a focus on agents relevant to childhood, adolescent and young adult NHL.
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Affiliation(s)
- Matthew J Barth
- Department of Pediatric Hematology/Oncology, University at Buffalo, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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9
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Casan JML, Wong J, Northcott MJ, Opat S. Anti-CD20 monoclonal antibodies: reviewing a revolution. Hum Vaccin Immunother 2018; 14:2820-2841. [PMID: 30096012 PMCID: PMC6343614 DOI: 10.1080/21645515.2018.1508624] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/14/2018] [Accepted: 08/02/2018] [Indexed: 12/23/2022] Open
Abstract
Since the inception of rituximab in the 1990s, anti-CD20 monoclonal antibodies have revolutionised the treatment of B cell hematological malignancies and have become a cornerstone of modern gold-standard practice. Additionally, the potent efficacy of these agents in depleting the B cell compartment has been used in the management of a broad array of autoimmune diseases. Multiple iterations of these agents have been investigated and are routinely used in clinical practice. In this review, we will discuss the physiology of CD20 and its attractiveness as a therapeutic target, as well as the pharmacology, pre-clinical and clinical data for the major anti-CD20 monoclonal antibodies: rituximab, obinutuzumab and ofatumumab.
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Affiliation(s)
- J. M. L. Casan
- Haematology Department, Monash Health, Melbourne Australia
| | - J. Wong
- Haematology Department, Monash Health, Melbourne Australia
| | - M. J. Northcott
- Rheumatology Department, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - S. Opat
- Haematology Department, Monash Health, Melbourne Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
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10
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The CD20-specific engineered toxin antibody MT-3724 exhibits lethal effects against mantle cell lymphoma. Blood Cancer J 2018; 8:33. [PMID: 29559616 PMCID: PMC5861115 DOI: 10.1038/s41408-018-0066-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/18/2017] [Accepted: 01/15/2018] [Indexed: 11/29/2022] Open
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11
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Viala M, Vinches M, Alexandre M, Mollevi C, Durigova A, Hayaoui N, Homicsko K, Cuenant A, Gongora C, Gianni L, Tosi D. Strategies for clinical development of monoclonal antibodies beyond first-in-human trials: tested doses and rationale for dose selection. Br J Cancer 2018; 118:679-697. [PMID: 29438365 PMCID: PMC5846071 DOI: 10.1038/bjc.2017.473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Our previous survey on first-in-human trials (FIHT) of monoclonal antibodies (mAbs) showed that, due to their limited toxicity, the recommended phase II dose (RP2D) was only tentatively defined. METHODS We identified, by MEDLINE search, articles on single-agent trials of mAbs with an FIHT included in our previous survey. For each mAb, we examined tested dose(s) and dose selection rationale in non-FIHTs (NFIHTs). We also assessed the correlation between doses tested in the registration trials (RTs) of all FDA-approved mAbs and the corresponding FIHT results. RESULTS In the 37 dose-escalation NFIHTs, the RP2D indication was still poorly defined. In phase II-III NFIHTs (n=103 on 37 mAbs), the FIHT RP2D was the only dose tested for five mAbs. For 16 mAbs, only doses different from the FIHT RP2D or the maximum administered dose (MAD) were tested and the dose selection rationale infrequently indicated. In the 60 RTs on 27 FDA-approved mAbs with available FIHT, the FIHT RP2D was tested only for two mAbs, and RT doses were much lower than the FIHT MAD. CONCLUSIONS The rationale beyond dose selection in phase II and III trials of mAbs is often unclear in published articles and not based on FIHT data.
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Affiliation(s)
- Marie Viala
- Institut du Cancer de Montpellier, Montpellier, France
| | - Marie Vinches
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | | | - Nadia Hayaoui
- Institut du Cancer de Montpellier, Montpellier, France
| | | | - Alice Cuenant
- Institut du Cancer de Montpellier, Montpellier, France
| | - Céline Gongora
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Montpellier, France
| | - Luca Gianni
- San Raffaele – Scientific Institute, Milan, Italy
| | - Diego Tosi
- Institut du Cancer de Montpellier, Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Montpellier, France
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12
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Combination of ofatumumab and reduced-dose CHOP for diffuse large B-cell lymphomas in patients aged 80 years or older: an open-label, multicentre, single-arm, phase 2 trial from the LYSA group. LANCET HAEMATOLOGY 2018; 4:e46-e55. [PMID: 28041583 DOI: 10.1016/s2352-3026(16)30171-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND In 2011 we reported a rituximab plus miniCHOP (reduced-dose cyclophosphamide, doxorubicin, vincristine, and prednisone) combination for patients older than 80 years with diffuse large B-cell lymphoma (DLBCL). The 2-year overall survival was 59% (95% CI 49-67) with an excess of early toxicity. To improve those results we tested the same chemotherapy protocol in combination with ofatumumab and a pre-phase treatment. METHODS For this open-label, multicentre, single-group, phase 2 trial, we recruited patients older than 80 years with untreated histologically-proven CD20-positive DLBCL, Ann Arbor stage I to IV, from 41 academic and hospital centres in France and Belgium. Patients received a pre-phase with oral vincristine (1 mg total dose 1 week before cycle 1 [day -7]) and oral prednisone (60 mg total dose starting 1 week before cycle 1, for 4 days [day -7 to day -4]) before the first cycle of the ofatumumab plus miniCHOP regimen. The regimen consisted of 1000 mg total dose of intravenous ofatumumab, 25 mg/m2 of intravenous doxorubicin, 400 mg/m2 of intravenous cyclophosphamide, and 1 mg of intravenous vincristine, on day 1 of each cycle; and 40 mg/m2 of oral prednisone on days 1-5. Ofatumumab was administered with 1000 mg of paracetamol and 50 mg of diphenhydramine. The primary endpoint was overall survival in the intention-to-treat population. The statistical analysis has been done on an intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT01195714. FINDINGS Between June 2, 2010, and Nov 4, 2011, we enrolled 120 patients. Age-adjusted International Prognostic Index was 2-3 in 68 (57%) of them. The median follow-up time was 26·8 months (IQR 24·5-30·1). The 2-year overall survival was 64·7% (95% CI 55·3-72·7) and median overall survival was not reached (95% CI 30·2-not reached). 45 patients died during the treatment, of whom 28 (62%) died due to lymphoma. The most common side-effect was haematological toxicity. Among the 120 patients, grade 3-4 neutropenia was reported in 24 (21%) patients and thrombocytopenia in two (2%), during the treatment period. Grade 3-4 anaemia was reported in six (5%) patients; seven (6%) patients had one episode of febrile neutropenia. 17 (15%) of 115 patients in the modified intention-to-treat population had red blood cell transfusions and three (3%) had platelet transfusions. INTERPRETATION Our result suggest that, in patients older than 80 years with DLBCL, ofatumumab and pre-phase treatment seem to improve overall survival compared with the previously reported data. The combination of pre-phase treatment, a monoclonal antibody against CD20, and miniCHOP can be considered a new treatment platform for use in randomised clinical trial design for DLBCL treatment in patients older than 80 years. FUNDING The Lymphoma Study Association, GlaxoSmithKline.
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Rezahosseini O, Hanaei S, Hamadani M, Keshavarz-Fathi M, Rezaei N. The promising role of monoclonal antibodies for immunotherapy of the HIV-associated cancer, non-Hodgkin lymphoma. Int Rev Immunol 2017; 37:165-173. [PMID: 29257907 DOI: 10.1080/08830185.2017.1405396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Association between HIV/AIDS and some of the cancers such as lymphomais is well known. Relative risk for developing non-Hodgkin lymphoma (NHL) increases 60-200 folds in HIV-infected individuals. Diffuse large B cell lymphoma (DLBCL), primary effusion lymphoma (PEL), Burkitt's lymphoma (BL) and Plasmablastic Lymphoma (PBL) are among the most frequent subtypes. During the last century, scientists found that the immune system could potentially detect and destroy cancer cells. Therefore, they started a new field of study, which is named immunotherapy. There are different immunotherapeutic methods, among which therapeutic antibodies, such as Brentuximabvedotin (Adcetris), Ibritumomabtiuxetan (Zevalin) and rituximab (Rituxan), used for treatment of NHLs showed promising results. In this article, we will review the immunotherapeutic option, monoclonal antibodies, for treatment of HIV-associated NHLs as well as their recent clinical status. We will also discuss the selective monoclonal antibody for each subtype of NHLs.
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Affiliation(s)
- Omid Rezahosseini
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,b Department of Infectious and Tropical diseases , Imam Khomeini Hospital Complex, Tehran University of Medical Sciences , Tehran , Iran
| | - Sara Hanaei
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,d School of Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | - Mehdi Hamadani
- e Division of Hematology & Oncology , Medical College of Wisconsin , Milwaukee , WI , USA.,f Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Milwaukee , WI , USA
| | - Mahsa Keshavarz-Fathi
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,d School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,g Students' Scientific Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Nima Rezaei
- c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,h Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,i Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Sheffield , UK
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14
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Soe ZN, Allsup D. The use of ofatumumab in the treatment of B-cell malignancies. Future Oncol 2017; 13:2611-2628. [DOI: 10.2217/fon-2017-0275] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Ofatumumab has been extensively studied in the treatment of B-cell malignancies. Currently, it has been approved for the treatment of chronic lymphocytic leukemia in a number of different situations. However, there is still no compelling evidence confirming the superiority of ofatumumab over rituximab in vivo. In this article, we summarize the currently available clinical data supporting the use of ofatumumab in the treatment of B-cell malignancies. The clinical studies were searched from clinicaltrials.gov with the key words ofatumumab, HuMax-CD20. Out of 115 trials available, studies for B-cell malignancies were selected, followed by selection of completed studies with results and active ongoing studies. The results from completed studies were thoroughly analyzed and active ongoing studies were listed in tables.
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Affiliation(s)
- Zar Ni Soe
- Department of Haematology, Hull & East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, England, UK
| | - David Allsup
- Department of Haematology, Hull & East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, England, UK
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15
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Pers YM, Jorgensen C. Perspectives of ofatumumab as CD20 targeted therapy in rheumatoid arthritis and other autoimmune diseases. Immunotherapy 2017; 8:1091-6. [PMID: 27485081 DOI: 10.2217/imt-2016-0003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune condition viewed as a severe destructive disease. The treatment strategies include anti-CD20 monoclonal antibody (mAb)-targeting B cells. Ofatumumab specifically targets a membrane-proximal epitope on the CD20 molecule distinct from other anti-CD20 antibodies including rituximab and ocrelizumab, and bind the epitope located on the large loop of CD20. This explains a more durable B-cell depletion and a different pharmacodynamic. We review the pharmacodynamic of B-cell depletion and analyze the results in RA and other B-cell-mediated autoimmune diseases. The randomized trial in RA showed clinical efficacy comparable to rituximab at week 24. However, structural impact has not been demonstrated. Studies including RA patients refractory to rituximab would be useful to define the optimal strategy of ofatumumab therapy.
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Affiliation(s)
- Yves Marie Pers
- Inserm, U1183, Hôpital Saint-Eloi, Montpellier, F-34295 France.,Université MONTPELLIER, UFR de Médecine, Montpellier, F-34000 France.,Service d'immuno-Rhumatologie, CHU Lapeyronie, Montpellier, F-34295 France
| | - Christian Jorgensen
- Inserm, U1183, Hôpital Saint-Eloi, Montpellier, F-34295 France.,Université MONTPELLIER, UFR de Médecine, Montpellier, F-34000 France.,Service d'immuno-Rhumatologie, CHU Lapeyronie, Montpellier, F-34295 France
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16
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Howlader N, Mariotto AB, Besson C, Suneja G, Robien K, Younes N, Engels EA. Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era. Cancer 2017; 123:3326-3334. [DOI: 10.1002/cncr.30739] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/20/2017] [Accepted: 02/08/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Angela B. Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
| | - Caroline Besson
- Faculty of Medicine; University of Paris Sud; Le Kremlin-Bicêtre France
| | - Gita Suneja
- Department of Radiation Oncology; University of Utah; Salt Lake City Utah
| | - Kim Robien
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Naji Younes
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda Maryland
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17
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Galanina N, Jasielec J, Peace D, Smith SM, Nabhan C. Ofatumumab monotherapy in relapsed/refractory diffuse large B-cell non-Hodgkin lymphoma. Leuk Lymphoma 2017. [DOI: 10.1080/10428194.2016.1207764 10.1080/10428194.2016.1207767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - David Peace
- The University of Illinois at Chicago, Chicago, IL, USA
| | | | - Chadi Nabhan
- The University of Chicago Medical Center, Chicago, IL, USA
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18
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Camus V, Tilly H. Managing early failures with R-CHOP in patients with diffuse large B-cell lymphoma. Expert Rev Hematol 2016; 10:1047-1055. [DOI: 10.1080/17474086.2016.1254547] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Vincent Camus
- Department of Hematology, Centre Henri Becquerel, Université de Rouen, IRIB, Rouen, France
| | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, Université de Rouen, IRIB, Rouen, France
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19
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Galanina N, Jasielec J, Peace D, Smith SM, Nabhan C. Ofatumumab monotherapy in relapsed/refractory diffuse large B-cell non-Hodgkin lymphoma. Leuk Lymphoma 2016; 58:752-753. [PMID: 27415580 DOI: 10.1080/10428194.2016.1207764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - David Peace
- c The University of Illinois at Chicago , Chicago , IL , USA
| | - Sonali M Smith
- a The University of Chicago Medical Center , Chicago , IL , USA
| | - Chadi Nabhan
- a The University of Chicago Medical Center , Chicago , IL , USA
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20
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Role of Rituximab and Rituximab Biosimilars in Diffuse Large B-Cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:175-81. [PMID: 26906106 PMCID: PMC10130787 DOI: 10.1016/j.clml.2016.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/22/2016] [Indexed: 12/27/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL), an aggressive non-Hodgkin lymphoma (NHL), is the most-common subtype of NHL. DLBCL can be classified into at least 3 major immunologically distinct types, which contributes to considerable variation in disease prognosis and response to treatment. DLBCL potentially is curable, even when diagnosed at advanced stages. The current standard of care for most patients with untreated or relapsed/refractory DLBCL is chemoimmunotherapy containing rituximab, an anti-CD20 monoclonal antibody. With advanced understanding of the molecular mechanisms involved in the pathogenesis of DLBCL and specific signaling pathways that are activated in different subtypes, potential new therapeutic targets have been identified, some of which are at the late stages of clinical development. This review summarizes the critical role of rituximab in the current standard of care treatment for DLBCL and discusses why rituximab is likely to remain an important component of treatment options for DLBCL in the foreseeable future. In addition, current and emerging therapeutic agents, including potential benefits of rituximab biosimilars, for patients with DLBCL are discussed. The advent of rituximab biosimilars may facilitate accessibility of rituximab-based chemotherapies to patients with DLBCL and has potential cost-saving benefits for healthcare systems globally.
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21
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Preclinical safety, pharmacokinetics, pharmacodynamics, and biodistribution studies with Ad35K++ protein: a novel rituximab cotherapeutic. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2016; 5:16013. [PMID: 27069950 PMCID: PMC4813608 DOI: 10.1038/mtm.2016.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 12/31/2022]
Abstract
Rituximab is a mouse/human chimeric monoclonal antibody targeted toward CD20. It is efficient as first-line therapy of CD20-positive B-cell malignancies. However, a large fraction of treated patients relapse with rituximab-resistant disease. So far, only modest progress has been made in treatment options for rituximab refractory patients. One of the mechanisms for rituximab resistance involves the upregulation of CD46, which is a key cell surface protein that blocks the activation of complement. We have recently developed a technology that depletes CD46 from the cell surface and thereby sensitizes tumor cells to complement-dependent cytotoxicity. This technology is based on a small recombinant protein, Ad35K++ that binds with high affinity to CD46. In preliminary studies using a 6 × histidinyl tagged protein, we had demonstrated that intravenous Ad35K++ injection in combination with rituximab was safe and increased rituximab-mediated killing of CD20-positive target cells in mice and nonhuman primates (NHPs). The presence of the tag, while allowing for easy purification by Ni-NTA chromatography, has the potential to increase the immunogenicity of the recombinant protein. For clinical application, we therefore developed an Ad35K++ protein without His-tag. In the present study, we performed preclinical studies in two animal species (mice and NHPs) with this protein demonstrating its safety and efficacy. These studies estimated the Ad35K++ dose range and treatment regimen to be used in patients. Furthermore, we showed that intravenous Ad35K++ injection triggers the shedding of the CD46 extracellular domain in xenograft mouse tumor models and in macaques. Shed serum CD46 can be measured in the serum and can potentially be used as a pharmacodynamic marker for monitoring Ad35K++ activity in patient undergoing treatment with this agent. These studies create the basis for an investigational new drug application for the use of Ad35K++ in combination with rituximab in the treatment of patients with B-cell malignancies.
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22
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Papadopoulos KP, Lopez-Jimenez J, Smith SE, Steinberg J, Keating A, Sasse C, Jie F, Thyss A. A multicenter phase II study of sepantronium bromide (YM155) plus rituximab in patients with relapsed aggressive B-cell Non-Hodgkin lymphoma. Leuk Lymphoma 2016; 57:1848-55. [PMID: 26857688 DOI: 10.3109/10428194.2015.1113275] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This phase II study evaluated YM155, a novel small-molecule survivin suppressant, in combination with rituximab in patients with relapsed aggressive B-cell non-Hodgkin lymphoma (NHL) who failed or were not candidates for autologous stem cell transplant (ASCT). During 14-day cycles, 41 patients received YM155 (5mg/m(2)/d) by continuous intravenous (IV) infusion for 168 hours (day 1-7), and rituximab (375mg/m(2)) IV on days 1 and 8 during cycles 1-4 and repeated for 4 cycles every 10 cycles. Forty patients (97.6%) had prior rituximab and 15 patients (36.6%) prior ASCT. Most frequent grade 3-4 adverse events were neutropenia (19.5%) and thrombocytopenia (12.2%). In the per-protocol set (n = 34), objective response rate was 50% and median progression-free survival 17.9 months. Median overall survival was not reached at study termination (median follow-up, 23 months). YM155 in combination with rituximab was tolerable with encouraging antitumor activity and durable responses in relapsed aggressive B-cell NHL patients.
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Affiliation(s)
| | | | | | | | | | | | - Fei Jie
- d Astellas Pharma , Northbrook , IL , USA
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23
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Cheah CY, Fowler NH, Wang ML. Breakthrough therapies in B-cell non-Hodgkin lymphoma. Ann Oncol 2016; 27:778-87. [PMID: 26802148 DOI: 10.1093/annonc/mdw029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/12/2016] [Indexed: 01/14/2023] Open
Abstract
The last 5 years have seen significant advances in our understanding of the molecular pathogenesis of B-cell lymphomas. This has led to the emergence of a large number of new therapeutic agents exploiting precise aspects of the tumor cell's signaling pathways, surface antigens or microenvironment. The purpose of this comprehensive review is to provide a detailed analysis of the breakthrough agents in the field, with a focus on recent clinical data. We describe agents targeting the B-cell receptor pathway, Bcl-2 inhibitors, emerging epigenetic therapies, new monoclonal antibodies and antibody drug conjugates, selective inhibitors of nuclear export, agents targeting the programmed cell death axis and chimeric antigen receptor T cells.
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Affiliation(s)
- C Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine WA, Nedlands University of Western Australia, Crawley, Australia
| | - N H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M L Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
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24
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Tumor lysis syndrome in the era of novel and targeted agents in patients with hematologic malignancies: a systematic review. Ann Hematol 2016; 95:563-73. [PMID: 26758269 DOI: 10.1007/s00277-015-2585-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/19/2015] [Indexed: 01/14/2023]
Abstract
Effective new treatments are now available for patients with hematologic malignancies. However, their propensity to cause tumor lysis syndrome (TLS) has not been systematically examined. A literature search identified published Phase I-III clinical trials of monoclonal antibodies (otlertuzumab, brentuximab, obinutuzumab, ibritumomab, ofatumumab); tyrosine kinase inhibitors (alvocidib [flavopiridol], dinaciclib, ibrutinib, nilotinib, dasatinib, idelalisib, venetoclax [ABT-199]); proteasome inhibitors (oprozomib, carfilzomib); chimeric antigen receptor (CAR) T cells; and the proapoptotic agent lenalidomide. Abstracts from major congresses were also reviewed. Idelalisib and ofatumumab had no reported TLS. TLS incidence was ≤5 % with brentuximab vedotin (for anaplastic large-cell lymphoma), carfilzomib and lenalidomide (for multiple myeloma), dasatinib (for acute lymphoblastic leukemia), and oprozomib (for various hematologic malignancies). TLS incidences were 8.3 and 8.9 % in two trials of venetoclax (for chronic lymphocytic leukemia [CLL]) and 10 % in trials of CAR T cells (for B-cell malignancies) and obinutuzumab (for non-Hodgkin lymphoma). TLS rates of 15 % with dinaciclib and 42 and 53 % with alvocidib (with sequential cytarabine and mitoxantrone) were seen in trials of acute leukemias. TLS mitigation was employed routinely in clinical trials of alvocidib and lenalidomide. However, TLS mitigation strategies were not mentioned or stated only in general terms for many studies of other agents. The risk of TLS persists in the current era of novel and targeted therapy for hematologic malignancies and was seen to some extent with most agents. Our findings underscore the importance of continued awareness, risk assessment, and prevention to reduce this serious potential complication of effective anticancer therapy.
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Solimando AG, Ribatti D, Vacca A, Einsele H. Targeting B-cell non Hodgkin lymphoma: New and old tricks. Leuk Res 2016; 42:93-104. [PMID: 26818572 DOI: 10.1016/j.leukres.2015.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/17/2015] [Accepted: 11/02/2015] [Indexed: 01/03/2023]
Abstract
The management of B-cell malignancies continues to pose a clinical challenge. In the past years, rituximab (anti-CD20) emerged as the standard of care in the induction treatment of follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic leukemia (CLL), and mantle cell lymphoma (MCL), as well as in other subsets. Since the benefits of immuno-chemotherapy have been clearly demonstrated in a whole range of lymphomas, several innovative approaches are being explored to achieve significant responses, particularly in refractory B-cell non-Hodgkin lymphoma (NHL) cases. Studies of the comparative effectiveness and structure/function relationship of therapeutic monoclonal antibodies, together with an increased understanding of the molecular features of NHLs, have led to the development of a range of novel therapies, many of which target the tumor in a tailored fashion. Although several molecules can help clinicians to dissect the pathological mechanisms acting in the natural history of the disease, the main purpose of this review emphasize the recent developments in targeting the B-cell NHLs surface. These novel approaches are illustrated, and the new intriguing opportunities offered by bispecific antibodies and antibody-associated immune modulation are addressed.
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Affiliation(s)
- Antonio Giovanni Solimando
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine "G. Baccelli", University of Bari Medical School, Bari, Italy.
| | - Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, National Cancer Institute "Giovanni Paolo II", Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine "G. Baccelli", University of Bari Medical School, Bari, Italy
| | - Hermann Einsele
- Department of Hematology/Oncology, University Medical Center Würzburg, Würzburg, Germany
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26
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Erker C, Harker-Murray P, Burke MJ. Emerging immunotherapy in pediatric lymphoma. Future Oncol 2015; 12:257-70. [PMID: 26616565 DOI: 10.2217/fon.15.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hodgkin and non-Hodgkin lymphoma collectively are the third most common cancer diagnosed in children each year. For children who relapse or have refractory disease, outcomes remain poor. Immunotherapy has recently emerged as a novel approach to treat hematologic malignancies. The field has been rapidly expanding over the past few years broadening its armamentarium which now includes monoclonal antibodies, antibody-drug conjugates and cellular therapies including bispecific T-cell engagers and chimeric antigen receptor-engineered T cells. Many of these agents are in their infancy stages and only beginning to make their mark on lymphoma treatment while others have begun to show promising efficacy in relapsed disease. In this review, the authors provide an overview of current and emerging immunotherapies in the field of pediatric lymphoma.
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Affiliation(s)
- Craig Erker
- Division of Pediatric Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Paul Harker-Murray
- Division of Pediatric Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Michael J Burke
- Division of Pediatric Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Dahlberg CIM, Sarhan D, Chrobok M, Duru AD, Alici E. Natural Killer Cell-Based Therapies Targeting Cancer: Possible Strategies to Gain and Sustain Anti-Tumor Activity. Front Immunol 2015; 6:605. [PMID: 26648934 PMCID: PMC4663254 DOI: 10.3389/fimmu.2015.00605] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/13/2015] [Indexed: 12/14/2022] Open
Abstract
Natural killer (NK) cells were discovered 40 years ago, by their ability to recognize and kill tumor cells without the requirement of prior antigen exposure. Since then, NK cells have been seen as promising agents for cell-based cancer therapies. However, NK cells represent only a minor fraction of the human lymphocyte population. Their skewed phenotype and impaired functionality during cancer progression necessitates the development of clinical protocols to activate and expand to high numbers ex vivo to be able to infuse sufficient numbers of functional NK cells to the cancer patients. Initial NK cell-based clinical trials suggested that NK cell-infusion is safe and feasible with almost no NK cell-related toxicity, including graft-versus-host disease. Complete remission and increased disease-free survival is shown in a small number of patients with hematological malignances. Furthermore, successful adoptive NK cell-based therapies from haploidentical donors have been demonstrated. Disappointingly, only limited anti-tumor effects have been demonstrated following NK cell infusion in patients with solid tumors. While NK cells have great potential in targeting tumor cells, the efficiency of NK cell functions in the tumor microenvironment is yet unclear. The failure of immune surveillance may in part be due to sustained immunological pressure on tumor cells resulting in the development of tumor escape variants that are invisible to the immune system. Alternatively, this could be due to the complex network of immune-suppressive compartments in the tumor microenvironment, including myeloid-derived suppressor cells, tumor-associated macrophages, and regulatory T cells. Although the negative effect of the tumor microenvironment on NK cells can be transiently reverted by ex vivo expansion and long-term activation, the aforementioned NK cell/tumor microenvironment interactions upon reinfusion are not fully elucidated. Within this context, genetic modification of NK cells may provide new possibilities for developing effective cancer immunotherapies by improving NK cell responses and making them less susceptible to the tumor microenvironment. Within this review, we will discuss clinical trials using NK cells with a specific reflection on novel potential strategies, such as genetic modification of NK cells and complementary therapies aimed at improving the clinical outcome of NK cell-based immune therapies.
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Affiliation(s)
- Carin I M Dahlberg
- Cell Therapies Institute, Nova Southeastern University , Fort Lauderdale, FL , USA ; Cell and Gene Therapy Group, Center for Hematology and Regenerative Medicine (HERM), Karolinska University Hospital Huddinge, NOVUM , Stockholm , Sweden
| | - Dhifaf Sarhan
- Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet , Stockholm , Sweden ; Division of Hematology, Oncology and Transplantation, Masonic Cancer Research Center, University of Minnesota , Minnesota, MN , USA
| | - Michael Chrobok
- Cell Therapies Institute, Nova Southeastern University , Fort Lauderdale, FL , USA ; Cell and Gene Therapy Group, Center for Hematology and Regenerative Medicine (HERM), Karolinska University Hospital Huddinge, NOVUM , Stockholm , Sweden
| | - Adil D Duru
- Cell Therapies Institute, Nova Southeastern University , Fort Lauderdale, FL , USA ; Cell and Gene Therapy Group, Center for Hematology and Regenerative Medicine (HERM), Karolinska University Hospital Huddinge, NOVUM , Stockholm , Sweden
| | - Evren Alici
- Cell Therapies Institute, Nova Southeastern University , Fort Lauderdale, FL , USA ; Cell and Gene Therapy Group, Center for Hematology and Regenerative Medicine (HERM), Karolinska University Hospital Huddinge, NOVUM , Stockholm , Sweden ; Hematology Center, Karolinska University Hospital Huddinge , Stockholm , Sweden
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A review of monoclonal antibody therapies in lymphoma. Crit Rev Oncol Hematol 2015; 97:72-84. [PMID: 26318093 DOI: 10.1016/j.critrevonc.2015.08.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/03/2015] [Accepted: 08/05/2015] [Indexed: 12/27/2022] Open
Abstract
Monoclonal antibodies (moAb) represent a novel way of delivering therapy through specific target antigens expressed on lymphoma cells and minimizes the collateral damage that is common with conventional chemotherapy. The paradigm of this approach is the targeting of CD20 by rituximab. Since its FDA approval in 1997, rituximab has become the standard of care in almost every line of therapy in most B-cell lymphomas. This review will briefly highlight some of the key rituximab trials while looking more closely at the evidence that is bringing other antibodies, including next generation anti-CD20 moAbs, and anti-CD30 moAbs, among others to the forefront of lymphoma therapy.
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Obinutuzumab in hematologic malignancies: lessons learned to date. Cancer Treat Rev 2015; 41:784-92. [PMID: 26190254 DOI: 10.1016/j.ctrv.2015.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/23/2015] [Accepted: 07/07/2015] [Indexed: 12/14/2022]
Abstract
The routine use of anti-CD20 monoclonal antibodies (mAbs) has improved patient outcomes in CD20-positive non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL). Despite the clinical success achieved with rituximab, relapses are still common with further improvements in anti-CD20 mAb efficacy required. Many novel anti-CD20 antibodies are in development, but obinutuzumab is currently the only type II glycoengineered anti-CD20 mAb in clinical testing. Obinutuzumab has increased antibody-dependent cell-mediated cytotoxicity, reduced complement-dependent cytotoxicity and enhanced direct non-apoptotic cell death. In preclinical models, obinutuzumab induced superior tumor remission compared with rituximab at the equivalent dose levels, and was active in rituximab-refractory tumors. Obinutuzumab exhibits encouraging efficacy as monotherapy in NHL, and combined with chemotherapy in relapsed/refractory NHL and treatment-naïve symptomatic CLL. In a recent randomized, phase III trial in patients with untreated comorbid CLL, overall response rate was significantly greater (78% vs. 65%, P<0.0001) and median progression-free survival was significantly prolonged (26.7 vs. 15.2months, P<0.0001) for obinutuzumab plus chlorambucil vs. rituximab plus chlorambucil. Obinutuzumab is a type II anti-CD20 antibody that utilizes distinct mechanisms of action relative to type I antibodies like rituximab and has led to significant clinical improvement over rituximab in a phase III trial in CLL. Further trials are ongoing to determine whether such improvements in outcome will be seen in CD20-positive B-cell malignancies.
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Abstract
INTRODUCTION Ofatumumab is a second-generation humanized monoclonal antibody targeting CD20 registered for the treatment of patients with relapsing/refractory chronic lymphocytic leukemia. This review will describe the activity of ofatumumab in patients with CD20 B-cell lymphomas. AREAS COVERED A review of all manuscript published on ofatumumab activity in B-cell lymphomas is presented with conclusions on the future use of this antibody in these patients. EXPERT OPINION Ofatumumab activity is low in indolent or aggressive B-cell lymphomas. The future of this drug is challenged by new monoclonal antibodies and new targeted drugs.
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Affiliation(s)
- Lionel Karlin
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hematology Department , 165, Chemin du Grand Revoyet 69495 Pierre-Benite , France +33 478864301 ; +33 478864355 ;
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Pérez-Callejo D, González-Rincón J, Sánchez A, Provencio M, Sánchez-Beato M. Action and resistance of monoclonal CD20 antibodies therapy in B-cell Non-Hodgkin Lymphomas. Cancer Treat Rev 2015; 41:680-9. [PMID: 26045227 DOI: 10.1016/j.ctrv.2015.05.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 11/18/2022]
Abstract
Anti-CD20 monoclonal antibodies (mAbs) have improved patient's survival with Non-Hodgkin Lymphoma, when combined with chemotherapy. Several mechanisms of action have been reported, including antibody-dependent cellular cytotoxicity, complement-dependent cytotoxicity and induction of apoptosis. Despite the large amount of studies and published data, the role each mechanism played in vivo is not fully understood. Furthermore, the reason why a significant percentage of patients are refractory or resistant remains unknown. Several activated intracellular signaling pathways have been implicated in the mechanisms of resistance of rituximab. In the present manuscript, we review those mechanisms and new anti-CD20 mAbs, as well as the efforts being accomplished to overcome it, focusing on new drugs targeting pathways implicated in resistance to rituximab.
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Affiliation(s)
- D Pérez-Callejo
- Medical Oncology Service, HU Puerta de Hierro-Majadahonda, Onco-Hematology Area, Instituto de Investigación Sanitaria Puerta de Hierro, Madrid, Spain.
| | - J González-Rincón
- Medical Oncology Service, HU Puerta de Hierro-Majadahonda, Onco-Hematology Area, Instituto de Investigación Sanitaria Puerta de Hierro, Madrid, Spain.
| | - A Sánchez
- Medical Oncology Service, HU Puerta de Hierro-Majadahonda, Onco-Hematology Area, Instituto de Investigación Sanitaria Puerta de Hierro, Madrid, Spain.
| | - M Provencio
- Medical Oncology Service, HU Puerta de Hierro-Majadahonda, Onco-Hematology Area, Instituto de Investigación Sanitaria Puerta de Hierro, Madrid, Spain.
| | - M Sánchez-Beato
- Medical Oncology Service, HU Puerta de Hierro-Majadahonda, Onco-Hematology Area, Instituto de Investigación Sanitaria Puerta de Hierro, Madrid, Spain.
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Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most frequent non-Hodgkin lymphoma in western countries. Despite the addition of rituximab to chemotherapy, the prognosis is still poor and almost one-third of patients fail or relapse after first-line treatment. Gene expression profiling has identified three main signatures related to subgroups with different biological characteristics and responses to treatment. Novel agents targeting the oncogenic drivers of these subsets are currently under investigation with the aim of providing a tailored approach and avoiding unnecessary toxicity. Herein, we review the emerging therapies for DLBCL with a focus on preclinical and early clinical trials as well as future directions.
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Affiliation(s)
- Patrizia Mondello
- Department of Human Pathology, University of Messina, Via C. Valeria, 98100 Messina, Italy
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Suresh T, Lee LX, Joshi J, Barta SK. New antibody approaches to lymphoma therapy. J Hematol Oncol 2014; 7:58. [PMID: 25355407 PMCID: PMC4172963 DOI: 10.1186/s13045-014-0058-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/29/2014] [Indexed: 01/01/2023] Open
Abstract
The CD20-directed monoclonal antibody rituximab established a new era in lymphoma therapy. Since then other epitopes on the lymphoma surface have been identified as potential targets for monoclonal antibodies (mAb). While most mAbs eliminate lymphoma cells mainly by antibody-dependent cellular cytotoxicity, complement-dependent cytotoxicity or direct cell death, others counter mechanisms utilized by malignant cells to evade immune surveillance. Expression of PD-L1 on malignant or stromal cells in the tumor environment for example leads to T-cell anergy. Targeting either PD-1 or PD-L1 via mAbs can indirectly eliminate cancer cells by unblocking the host intrinsic immune response. Yet another mechanism of targeted therapy with mAbs are bi-specific T-cell engagers (BiTE) such as blinatumomab, which directly engages the host immune cells. These examples highlight the broad spectrum of available therapies targeting the lymphoma surface with mAbs utilizing both passive and active immune pathways. Many of these agents have already demonstrated significant activity in clinical trials. In this review we will focus on novel CD20-directed antibodies as well as mAbs directed against newer targets like CD19, CD22, CD40, CD52 and CCR4. In addition we will review mAbs unblocking immune checkpoints and the BiTE blinatumomab. Given the success of mAbs and the expansion in active and passive immunotherapies, these agents will play an increasing role in the treatment of lymphomas.
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Yang SH, Hsu C, Cheng AL, Kuo SH. Anti-CD20 monoclonal antibodies and associated viral hepatitis in hematological diseases. World J Hematol 2014; 3:29-43. [DOI: 10.5315/wjh.v3.i2.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/27/2014] [Accepted: 03/18/2014] [Indexed: 02/05/2023] Open
Abstract
Over the past decade, the administration of anti-CD20 monoclonal antibodies such as rituximab has demonstrated various degrees of effectiveness and has improved patients’ outcomes during the treatment of autoimmune hematological disorders and hematological malignancies. However, the depletion of B-cells, the distribution of T-cell populations, and the reconstruction of host immunity resulting from the use of anti-CD20 monoclonal antibodies potentially lead to severe viral infections, such as hepatitis B virus (HBV), hepatitis C virus (HCV), parvovirus B19, and herpes viruses, in patients who are undergoing immune therapy or immunochemotherapy. Of these infections, HBV- and HCV-related hepatitis are a great concern in endemic areas because of the high morbidity and mortality rates in untreated patients. As a result, prophylaxis against HBV infection is becoming a standard of care in these areas. Parvovirus B19, a widespread pathogen that causes red blood cell aplasia in immunocompromised hosts, also causes hepatitis in healthy individuals. Recently, its association with hepatitis was recognized in a patient treated with rituximab. In addition, adenovirus, varicella-zoster virus, hepatitis E virus, and rituximab itself have been linked to the occurrence of hepatitis during or after rituximab treatments. The epidemiologies and pathogeneses of these etiologies remain unknown. Because of the increasing use of anti-CD20 monoclonal antibodies for the treatment of hematological malignancies or autoimmune hematological disorders, it is imperative that physicians understand and balance the risks of hepatotropic virus-associated hepatitis against the benefits of using anti-CD20 monoclonal antibodies.
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Corrigendum. Br J Haematol 2014. [DOI: 10.1111/bjh.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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