What Are the Treatment Options When Lymphoma Returns? – SurvivorNet

Dr. Stephen Schuster Penn Medicine

Finally entering into remission after youve gone through several weeks or months worth of treatment for non-Hodgkin lymphoma can feel like a huge victory. Sometimes remissions are long lasting, but in a certain percentage of people, the cancer can eventually return. If your cancer does stage a comeback, your doctor will be ready with another round of treatment that oncologists call second-line therapy.

What tools do we have for the second line? Well, the standard right now is the high-dose chemotherapy with autologous stem cell rescue approach, Dr. Stephen Schuster, medical oncologist at Penn Medicine, tells SurvivorNet. An autologous stem cell transplant gives you an infusion of your own stem cells the preliminary cells that will eventually grow into new blood cells to replace the ones chemotherapy destroys. It allows your doctor to give you very high doses of chemo to treat your cancer.

In the late 1980s and 1990s, stem cell therapy worked pretty well in about one-third of people who received it. But as doctors improved upon the first-line treatment in the early 2000s by combining chemotherapy with the monoclonal antibody rituximab (Rituxan) into a drug cocktail called R-CHOP, stem cell therapy no longer worked as well in the second line. The hunt was on for a new way to treat relapsed non-Hodgkin lymphoma.

Fortunately, several new and improved cancer treatments have been introduced, and other novel therapies are under investigation. It took us from the 1970s to the late 90s to improve on the four drug combination CHOP, which is still the standard, adding rituximab to that, Dr. Schuster says. Today, not only have the treatments gotten better, but the pace of new drug development has sped up, he says. Several new immunotherapies have come out, just in the last few years.

One new therapeutic option if your cancer has returned is immunotherapy harnessing the power of your immune system to go after your cancer. [Immunotherapy is] frequently discussed in the popular scientific literature, Dr. Schuster says. Some of it sounds like science fiction. Its very cool stuff.

One group of immunotherapy drugs, collectively known as the monoclonal antibodies, use a protein called an antibody to home in on a target on the surface of cancer cells. Rituxan is one such drug.

A few new immunotherapy drugs have been approved for non-Hodgkin lymphoma in recent years:

Chimeric antigen receptor (CAR) T-cell therapy is one of the newest high-tech cancer treatments. During this therapy, your treatment team will take your own immune cells, called T cells, and genetically modify and multiply them in a lab so that they attach to proteins on the surface of your lymphoma cells and attack them.

These treatments each work in a slightly different way. And they can be effective for people whove tried and failed at two previous treatments.

Were coming up with the best approaches for people who were not successfully treated by first- or second-line approaches, Dr. Schuster says.There are currently two FDA-approved CAR T products for people with diffuse large B-cell lymphoma who have failed two prior lines of treatment.

Say youve tried three separate treatments and your cancer has come back again. It can be frustrating to face yet another round of treatment, but here again, innovation is your friend.

Soon, another therapy called bispecific antibodies or bispecific T-cell engagers (BiTEs),is likely to be added to the mix, says Dr. Schuster. Unlike monoclonal antibodies, which attach to only one target, bispecific antibodies bind to two targets at once. They essentially pull together your immune cells and cancer cells to help your immune system more effectively treat your cancer.

With so many non-Hodgkin lymphoma therapies available, theres a much better chance that your doctor will eventually find something that works for your cancer. If youve been through several rounds of treatment without success, you can always consider enrolling in a clinical trial of a new and as-yet unapproved drug that be more effective than anything youve already tried.

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Dr. Stephen Schuster is a medical oncologist and director of the Lymphoma Program at Penn Medicine. He is also theRobert and Margarita Louis-Dreyfus Professor in Chronic Lymphocytic Leukemia and Lymphoma Clinical Care and Research. Read More