How Targeted Therapy & Immunotherapy Are Transforming Lymphoma Care

Cancer is a serious global health issue, and specialists are constantly exploring for more effective and less hazardous treatment options.

In recent years, targeted therapy and immunotherapy have emerged as viable alternatives to chemotherapy and radiation therapy in lymphoma and other malignancies. These treatments have significantly improved patient outcomes, but their efficacy varies depending on the cancer type and patient factors.

Lymphoma is a type of cancer that begins in lymphocytes which are the immune system’s infection-fighting cells. Lymphomas originate when healthy lymphocytes convert into malignant cells; thus, lymphomas can be classed as B cell lymphomas (the most common), T cell lymphomas, or NK cell lymphomas (rare).

Lymphoma is a serious malignancy expressing as Hodgkin lymphoma, which affects only approximately 10% of individuals and non-Hodgkin lymphoma (NHL) accounting for the great majority (90%) of cases.

Each year, an estimated 590,000 new instances of lymphoma are reported, with 270,000 deaths from the disease worldwide.

Sharing his views on the role of targeted therapy & immunotherapy in transforming lymphoma care, Dr. Parveen Jain, Senior Consultant & HOD- Oncology at Aakash Healthcare, said, “Targeted therapy is the use of drugs or other chemicals that are specifically tailored to assault specific proteins on lymphoma cells. The proteins they target are far more prevalent in lymphoma cells than in healthy cells. Proteins are frequently used to aid cancer cell growth and survival. This means they can destroy lymphoma cells while having fewer effects on healthy cells, potentially resulting in fewer adverse effects.”

Immunotherapy, on the other hand, causes the immune system to recognize and attack lymphoma cells.

Precision diagnostics for personalized treatment

Before targeted therapy or immunotherapy can be administered, a precise diagnosis is essential to identify the specific type and stage of lymphoma, along with its unique molecular and genetic features.

Speaking on the role of imaging and diagnostics in lymphoma care, Dr. Sunita Kapoor, CEO & Chief of Pathology, at City Imaging & Clinical Labs said, “Advanced imaging technologies help stage the cancer by detecting the size and location of tumours throughout the body. A PET-CT scan, in particular, is critical for identifying metabolically active lymphoma cells, which helps in assessing a patient’s initial prognosis and monitoring their response to treatment.”

Pathological lab services such as immunohistochemistry is the gold standard for diagnosing lymphoma.  Other tests like the “Lymphoma Panel help to identify the specific markers on lymphoma cells, such as CD20, CD30, or CD19. This molecular analysis directly informs the choice of targeted therapies, such as CD30-targeting brentuximab vedotin, or CAR-T cell therapy, which often targets CD19, she added.

High-end diagnostic services are also crucial for the successful implementation and management of immunotherapy. Biomarker analysis helps determine if the tumor is likely to respond to a certain class of drugs like pembrolizumab

After a patient undergoes CAR-T cell therapy, regular diagnostic tests are needed to monitor for the potential side effects of cytokine release syndrome (CRS) and to track the success of the treatment.

“There are various types of targeted treatment, depending on the protein being attacked, pointed out.” Dr. Pratik Patil, Consultant, Medical Oncology at Jupiter Hospital. “B-cell receptor pathway inhibitors disrupt signals in B cells that are out of control in B-cell lymphoma. Blocking the signals can cause the B cells to die or cease dividing. BTK drugs inhibit the protein Bruton’s tyrosine kinase (BTK). BTK plays an important part in B cell development.”

PI3K inhibitors inhibit the protein phosphatidylinositol 3-kinase (PI3K). PI3K regulates cell growth and survival. BCL-2 inhibitors prevent the BCL-2 protein from functioning properly, allowing them to live longer than necessary. This initiates the process of natural cell demise.

Proteasome inhibitors prevent proteasomes from working, causing proteins to accumulate in lymphoma cells. This indicates the cells are no longer able to function properly and will die.

Highlighting the role of immunotherapy, Dr. Vibhor Sharma, Sr Consultant & Head – BMT & Medical Oncology (Unit II) at Asian Hospital said, “Several forms of immunotherapies are currently being employed to treat cancer, each operating in a unique way to activate or assist the immune system’s battle against cancer cells. One of the most notable benefits of immunotherapy is the possibility of long-term remission, even after treatment has ended. Traditional therapies like as chemotherapy and radiation damage both healthy and malignant cells, resulting in a variety of adverse effects. Immunotherapy, on the other hand, is typically more targeted.

Checkpoint inhibitors block the protein that lymphoma cells employ to hide from the immune system. This indicates that your T lymphocytes can detect and fight lymphoma cells. These have demonstrated extraordinary success in treating many forms of cancer.

Chimeric Antigen Receptor (CAR) T-cell therapy uses modified T cells to express particular receptors that target cancer cells. Certain blood cancers like diffuse large B-cell lymphoma (DLBCL) and acute lymphoblastic leukemia (ALL) have responded particularly well to the therapy.

Monoclonal antibodies are synthetic proteins that mimic the immune system’s ability to battle harmful invaders. Some monoclonal antibodies target cancer cells for destruction.

Cytokine therapy can increase immune cell growth and activity, enhancing the body’s ability to combat cancer. While cytokine therapy is less common today, it lay the framework for contemporary immunotherapies.