A tumor that affects approximately 4,400 Italians every year, mostly elderly and males. And that in 40% of cases he is not cured by the therapies used in the first instance. We are talking about diffuse large B cell lymphoma, the most frequent form of non-Hodgkin’s lymphoma. An aggressive and difficult to treat tumor in the management of which there is a strong need for new therapeutic tools. The good news is that there are several new drugs on the horizon. “The therapeutic algorithm has been greatly simplified thanks to immunotherapy: today we know that when the first-line treatment does not work, we are faced with the whole range made available by drugs and therapies that exploit the immune system, from CAR-T to new antibodies , which can also be combined with other drugs or bispecific ”, explains Paolo Corradini, director of the Hematology Division, IRCCS National Cancer Institute Foundation in Milan.
New opportunities
Today, patients with diffuse large B-cell lymphoma first receive an immunochemotherapy scheme consisting of rituximab – a monoclonal antibody that recognizes the CD20 antigen – plus 4 drugs, called R-CHOP. In this way, complete remission without subsequent relapses is achieved for 50-60% of patients. For the remaining 50-40% of patients, the second line of therapy involves high-dose chemotherapy with autologous stem cell transplantation. But even in this case it is not a road that always leads to recovery: for some patients it is not an option, because their health conditions do not allow it, in others it does not have the desired effect. Precisely for those who have undergone R-CHOP with no tangible results, for those in whom the transplant was not effective and for people who are not eligible for transplant in the first instance, it is necessary to seek further prospects for treatment. “One of the new approaches employed is the use of the monoclonal antibody tafasitamab which, unlike the rituximab used in R-CHOP, does not recognize the CD20 antigen, but rather the CD19. In this way we go to “target” an antigen that has never been hit before: all first-line immunological therapies target the CD20 antigen “, underlines Antonio Pinto, Director of the SC of Oncological Hematology of the National Cancer Institute, Pascale Foundation , IRCCS, Naples.
In the course of the studies, the researchers realized that tafasitamab works even better when given in combination with lenalidomide, a drug, the latter, which falls into the class of immunomodulatory or immunomodulatory drugs. “Compared to other new drugs that are arriving on the market, this combination has given more convincing results in terms of survival free from disease progression, which has exceeded 16 months”, says Pier Luigi Zinzani, Professor of Hematology, Institute of Hematology ” Seràgnoli ”University of Bologna, IRCCS University Hospital of Bologna. Combination that Italian patients were able to access during the trials, which in effect represent a great opportunity for doctors and patients. “Conducting a trial contributes to the development of knowledge, and through research it is possible to improve the life expectancy of patients”, continues Corradini. “In addition, it produces an economic value in terms of non-expenditure for the Health System: the patient who enters a trial has a new chance of treatment available without the Health System having to pay for it. Instead of delivering ineffective therapies, which cost in terms of hospitalizations, therapies and examinations, the Health System can deliver therapies that increase survival rates at no cost. For doctors, experiments represent an opportunity to learn new things; for young researchers to have better and innovative training; and also in this case the health system gains ”.
The European positive opinion
And the tafasitamab-lenalidomide combination has received the positive opinion of the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency: the first step in the path that will lead to the commercialization of the treatment and therefore, hopefully in the coming months , to its availability for all Italian patients.
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