A new type of treatment for Lymphoma
Lymphoma is a cancer that starts in the lymph glands or the lymphatic system. Lymph glands drain away waste fluids from the body and also contain cells that fight infections. The lymphatic system is the tubes, vessels and glands that connect lymph nodes together, plus the spleen.
Types of Lymphoma
There are two main types of Lymphoma; Hodgkin Lymphoma (cancer of white blood cells called lymphocytes) and Non-Hodgkin Lymphoma (a cancer of the lymphatic system). There are more than 60 types of Non-Hodgkin Lymphoma, which each behave differently and need different treatments.
Lymphoma is the fifth most common type of cancer in the UK. It can occur at any age, including in children. Most people live for many years after being diagnosed with lymphoma.
There are 14,176 cases of Non-Hodgkin Lymphoma in the UK every year on average. More than half of all cases will survive for more than 10 years. There are about 2,100 cases of Hodgkin Lymphoma in the UK each year and about 80% will survive for more than 5 years after diagnosis.
Large B cell Lymphoma
There are some types of Non-Hodgkin Lymphoma, however, where survival rates are much worse. Large B cell Lymphoma accounts for about 40% of all Non-Hodgkin Lymphoma cases, about 5,500 people each year. Around 60% will survive for 5 years or more. It is more common in males than females.
Some cases become resistant to treatment (“refractory”) and some patients relapse quickly after treatment. If first-line chemotherapy fails, the prognosis for these patients is often poor.
Now in research published at the end of 2021 a new type of drug (“Yescarta”) has been shown to quadruple survival rates amongst this population.
Yescarta and CAR-T treatment
In a landmark study (the ZUMA-7 Trial) scientists have shown the results of the first large randomised trial tracking the CAR-T
treatment. It is the only study so far to show two years of ‘event free’ survival data.
The research published in the New England Journal of Medicine showed that Yescarta therapy led to significant improvements,
as compared with standard care, in event-free survival and response.
At the two-year study point, median survival in the group treated with a placebo was two months. In the group treated with Yescarta it was over eight months. Furthermore, complications arising from treatment were lower in the group treated with Yescarta.
“Beyond the poor prognosis, patients also face substantially decreased quality of life with chemotherapy and stem cell transplant
treatments,” said Mahmoud Elsawy MD who led the trial, continuing “with the primary results of ZUMA-7, we see that Yescarta offers superior clinical outcomes and it provides a better quality of life – not just more but also better quality time.”
How CAR-T treatment works
CAR-T treatment aims to stimulate the patients’ own immune system to attack their tumours. This is achieved by genetically modifying T cells (which fight infections in the body) to kill specific types of cancer cells.
CAR-T treatment is currently only available for a very limited number of cancers, specifically Leukaemia and Lymphoma. It can also
have serious side effects, particularly neurotoxicity and cytokine release syndrome. The FDA has required Yescarta to carry a Risk Evaluation and Mitigation Strategy Statement. It shows that although there are benefits, the risks to using the drug can be very serious.
How the drug is being used
Because the side effects can be fatal, treatment with Yescarta is currently limited to those who have not responded to other
treatments. Scientists are gathering more data about how to make the therapy less dangerous to patients.
However, extending survival and improving quality of life for those with few other options will bring benefit to many thousands of
patients every year. The hope is that the therapy will become even more effective and that risks will be reduced further in time.
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