Laurie Sehn, M.D., M.P.H., a hematologist and clinical professor with the BC Cancer Centre for Lymphoid Cancer and the University of British Columbia in Vancouver, Canada, often treats people diagnosed with non-Hodgkin’s lymphoma (NHL), a type of blood cancer that occurs when malignant (cancerous) cells form in the lymph system.1 The most common aggressive, or fast-growing, subtype of NHL is diffuse large B cell lymphoma (DLBCL).2 Dr. Sehn discusses how patients who are newly diagnosed with DLBCL typically have been treated and the importance of raising the bar in developing innovative therapies that can reduce the risk of relapse and the need for subsequent therapies.
1. How do patients commonly react when they receive a diagnosis of DLBCL?
When patients with DLBCL come to me, they've typically already been informed of their diagnosis by one of their other healthcare providers. They often don’t fully understand it, so many are anxious and think a cancer diagnosis is a death sentence. When we talk about the available treatment options they are often relieved to learn that there may be effective treatment options, even for patients who have aggressive forms of lymphoma, like DLBCL. That lets them focus on what’s next, and ask, “What can I do to have the best chance at remission?” and “What is treatment going to involve?"
2. HOW IS SOMEONE WHO IS NEWLY DIAGNOSED WITH DLBCL TYPICALLY TREATED?
Since 2006, the standard approach to treating patients newly diagnosed with DLBCL has been a chemotherapy combination given with a monoclonal antibody – a protein made in the lab that can bind to certain targets in the body – and a steroid. Although this first-line treatment regimen is effective, in four out of 10 patients, the cancer either does not respond or returns after initial successful therapy. Most relapses following initial treatment occur within two years of starting therapy. Patients who relapse and require subsequent rounds of treatment are often exposed to additional toxicities and greater financial burdens.
3. Why is treatment success so important for people with DLBCL who have not yet been treated?
The goal of therapy for patients newly diagnosed with DLBCL is to give them the best chance of preventing their cancer from returning. By treating them with an effective initial therapy at the onset of their disease, the likelihood of relapse and need for subsequent treatments is reduced.
4. CAN YOU SPEAK TO ANY CHALLENGES WITH THE TREATMENT FOR PATIENTS WITH DLBCL WHO HAVE NOT RECEIVED PRIOR THERAPY? WHY ARE OTHER TREATMENT OPTIONS IMPORTANT TO IMPROVE OUTCOMES FOR THESE PATIENTS?
Patients newly diagnosed with DLBCL whose cancer either does not respond or returns after treatment face a very challenging situation because the likelihood of a positive outcome decreases. That is why it’s so important to give patients an effective treatment early and continue to raise the bar through scientific innovation to provide effective and tolerable options for patients newly diagnosed with this aggressive lymphoma.
5. What treatment advances and innovations may be beneficial for patients and caregivers to explore?
Advances in our understanding of the biology of lymphoma have led to extensive ongoing research into the development of new treatments to improve outcomes for patients with lymphoma, including DLBCL.
One class of medicine that has contributed to these advancements is an antibody drug conjugate (ADC), which is comprised of a monoclonal antibody linked to a chemotherapy medicine. The way an ADC works is by finding and honing in on a specific target on cancer cells, and in the case of DLBCL, a B cell target that is commonly present. The ADC is designed to attach to a specific protein on the B cell, including those that are cancerous, enters the B cell, and then releases the chemotherapy, which can kill the B cell.
6. What is your hope when treating patients with newly diagnosed DLBCL?
My hope is that we can eradicate the lymphoma and reduce the patient’s risk of relapse and need for additional treatments. If we can increase the chance that a patient newly diagnosed with an aggressive form of non-Hodgkin’s lymphoma achieves remission after their first treatment, we can improve their chance of a positive outcome earlier on in their journey with this disease.
This story is part of the Burden of Relapse series, which explores the impact of blood cancer relapse and the importance of advancing science on behalf of patients. To learn more about DLBCL and other blood cancers, visit Genentech’s Hematology Hub.