Academy-Award-winning actress Jane Fonda, 84, recently took to Instagram with some health news:
“So, my dear friends, I’ve something personal I would like to share. I am identified as having non-Hodgkin’s lymphoma and also have started chemo treatments. It is a very treatable cancer. 80% of individuals survive, therefore i feel very lucky. I’m also lucky because I’ve medical health insurance and usage of the very best doctors and treatments. I realize, and it’s really painful, that I’m privileged in this. Nearly every family in the us has had to cope with cancer at once or another and too many don’t have usage of the quality healthcare I’m receiving, which isn’t right.”
Fonda has started six months of chemotherapy and says she actually is tolerating the treatments fairly well.
She also stressed that she intends to keep her activist causes, like the climate change-based Fire Drill Fridays and supporting candidates for the upcoming midterm elections.
Non-Hodgkin lymphoma (NHL) comprises a heterogeneous band of lymphoproliferative malignancies with differing patterns of behavior and responses to treatment.
NHL usually originates in lymphoid tissues and will spread to other organs. NHL is a lot less predictable than Hodgkin lymphoma and contains a lot better predilection to disseminate to extranodal sites. The prognosis depends upon the histologic type, the stage, and treatment.
Based on the NCI, around 80,470 new cases of NHL and 20,250 deaths from NHL will occur in the U.S. in 2022. Approximately 2.1% of women and men will be identified as having NHL at some time throughout their lifetime. In 2019, there have been around 763,401 people surviving in the U.S. with NHL. The entire 5-year survival rate is 73.8%, although people that have stage I disease might have a 5-year survival rate of 86.5% versus 63.9% for patients with stage IV disease.
NHL could be split into two prognostic groups: indolent and aggressive.
Indolent NHL includes a relatively good prognosis, with a median survival provided that 20 years, but these lymphomas will not be curable in advanced clinical stages. Early-stage (stages I/II) could be effectively treated with radiation therapy alone. The majority of the indolent types are nodular (or follicular) in morphology.
Indolent NHL grows slowly and perhaps might not cause symptoms for a long time. People who have indolent NHL could postpone treatment until their symptoms worsen, without unwanted effects on survival.
Aggressive NHL grows and spread quickly, and usually requires immediate treatment. With modern treatment regimens, almost 70% of individuals with aggressive NHL will undoubtedly be considered cured.
Advances in Lymphoma Treatment
The mainstays of treatment for the various kinds of NHL have already been chemotherapy, radiation therapy, and the targeted therapy rituximab (Rituxan). A stem cell transplant may also be useful for lymphoma which has recurred, however the procedure carries risks. Two chimeric antigen receptor (CAR) T-cell therapies have already been approved to take care of some forms of recurrent lymphoma, though a lot of people with recurrent lymphoma will die of these cancer.
Most research on treatment for NHL is currently centered on targeted therapy and immunotherapy. Researchers may also be attempting to identify genetic changes in various kinds of lymphoma that could be targets for new drug development.
For instance, in 2018 a report led by NCI researchers identified genetic subtypes of diffuse large B-cell lymphoma (the most typical kind of NHL) which could help explain why some patients with the condition react to treatment among others don’t. Further studies can lead to more tailored treatments for patients with this particular kind of lymphoma.
Various kinds of NHL are driven by way of a signaling pathway called the B-cell receptor signaling pathway. A drug called ibrutinib (Imbruvica) has been developed to turn off that pathway. Within the last many years, the drug has been approved for the treating small lymphocytic lymphoma and Waldenstrom macroglobulinemia, two forms of indolent NHL. Ibrutinib in addition has received approval for mantle cell lymphoma (which may be aggressive or indolent) and marginal zone lymphoma (indolent).
The FDA in addition has approved two other drugs targeting the B-cell receptor signaling pathway:
- Acalabrutinib (Calquence), which includes received approval for relapsed mantle cell lymphoma and small lymphocytic lymphoma
- Zanubrutinib (Brukinsa), also approved for relapsed mantle cell lymphoma
A great many other targeted therapies are increasingly being tested in NHL. Some which have been approved for specific subtypes include:
- Polatuzumab vedotin (Polivy), for the treating diffuse large B-cell lymphoma
- Venetoclax (Venclexta), for small lymphocytic lymphoma
It’s been discovered that, in lymphoma, resistance to an individual agent may appear quickly. Researchers are actually testing combinations of targeted therapies to take care of NHL to attempt to overcome this resistance.
CAR T-cell therapies certainly are a kind of treatment when a patient’s T cells are changed in the laboratory so that they will attack cancer cells. In 2017, FDA approved the initial CAR T-cell therapy — axicabtagene ciloleucel (Yescarta) — for those who have large B-cell lymphomas whose cancer has progressed after receiving at the very least two prior treatment regimens.
CAR T-cell therapy have provided long-term remissions for approximately a third of adults with lymphoma who receive them. Two large randomized trials (ZUMA-7 and TRANSFORM) discovered that patients who received CAR-T therapy following a single round of chemotherapy lived disease-free longer than those that had the typical treatment approach. Furthermore, the ZUMA-7 study estimated that more patients treated with CAR-T therapy were alive 24 months later, weighed against traditionally treated patients.
Immunomodulators are drugs that either stimulate or suppress the disease fighting capability. One particular drug, lenalidomide (Revlimid), has been approved in conjunction with targeted therapies for previously treated follicular lymphoma, marginal zone lymphoma, and diffuse large B-cell lymphoma.
Researchers may also be testing novel methods to stimulate the disease fighting capability to fight lymphoma. In 2018, a little trial showed that combining radiation therapy with the injection of a compound that stimulates the disease fighting capability could shrink some indolent B-cell lymphomas. In 2019, an effort which used a vaccine to draw immune cells into tumors in people who have indolent NHL also showed promising results. A phase II trial testing this plan in conjunction with an immune checkpoint inhibitor happens to be underway.
Immunotherapy drugs called bispecific antibodies may also be under development. These drugs bind to lymphoma cells and your body’s own immune cells simultaneously to create them together. This enables the immune cells to kill the lymphoma cells. Five bispecific antibodies come in clinical trials for numerous kinds of lymphoma, including:
- Glofitamab, which in a phase I trial shrank aggressive lymphoma in individuals who had received several prior treatments
- Epcoritamab, which also shrank previously treated aggressive lymphoma within an early-phase clinical trial
- Mosunetuzumab, which triggered long-lasting remissions in almost 20% of individuals with aggressive B-cell NHL and almost 50% of individuals with indolent B-cell NHL within an early-phase clinical trial
Michele R. Berman, MD, is really a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children’s Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the news.