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Targeted Therapies

Targeted therapies are treatments that work by using the body's own immune system to fight the cancer.

There are different types of targeted therapies, including:

• Monoclonal antibodies
• Cell Signal Blockers
• Immunomodulators
• Antibody-Medicine Conjugates
• Checkpoint Inhibitors

Monoclonal Antibodies

Monoclonal antibodies are a more specific therapy than chemotherapy, meaning that they are directed at a target that is primarily located on tumour cells, as opposed to normal body cells. Monoclonal antibody drugs are treatments that enlist natural immune system functions to fight cancers. These drugs may be used in combination with other treatments. Not only does this make for very effective lymphoma treatment, it also greatly reduces the side effects, as normal cells are minimally affected.

How do monoclonal antibodies work?

One way the immune system attacks foreign substances in the body is by making large numbers of antibodies. An antibody is a protein that sticks to a specific protein called an antigen. Antibodies circulate throughout the body until they find and attach to the antigen. Once attached, they can recruit other parts of the immune system to destroy the cells containing the antigen.

Researchers can design antibodies that specifically target a certain antigen, such as one found on cancer cells. They can then make many copies of that antibody in the lab. These are known as monoclonal antibodies (mAbs).

Several monoclonal antibodies are available for the treatment of NHL and many more are under clinical investigation. The most commonly used monoclonal antibody in the treatment of lymphoma is MabThera® (rituximab).

Cell Signal Blockers

We now understand a lot more about the pathways within lymphoma cells that make them divide and keep them alive. Often signals reaching the surface trigger a series of steps along one or more pathways for the lymphoma cell to be able to divide and survive. Scientists have found that blocking either the signal or a key step in the pathway can make the lymphoma cells die.

A number of new medicines have been developed to target these signals and pathways. Ibrutinib is one such new medicine that targets an important pathway in B cells and it starting to be used successfully in some B cell lymphomas and clinical trials are being utilised to work out how to best use this medicine.

Immunomodulators

There are now new medicines that can change the response of the immune system in a person who has lymphoma called immunomodulator medicines. Lenalidomide is one such new medicine that modulates the immune system in a number of ways. These include blocking some of the signals between immune system cells, also blocking some of these signals inside lymphoma cells and stopping new blood vessels being able to grow in or around the lymphoma cells therefore causing the lymphoma cells to stop growing and die.

Antibody-Medicine Conjugates

These new medicines are made up of an antibody which targets lymphoma cells joined to a chemotherapy medicine. This chemotherapy medicine cannot simply be given into the blood stream on its own because of its side effects, so the antibody it is joined to, allows the chemotherapy medicine to be delivered directly to the lymphoma cells. The lymphoma cells can therefore die without the wide spread side effects of the chemotherapy.

These medicines include Brentuximab Vedotin which is a new targeted medicine being used in certain types of lymphoma by targeting the CD30 protein found on the surface of lymphoma cells.

Checkpoint Inhibitors

Check point inhibitors are a new class of medicines that block signalling through check points in a cell which are used by lymphomas to evade detection by your immune system. These medicines include Nivolumab which is a checkpoint inhibitor that binds to the PD-1 receptor on a cell allowing the body to launch an anti -lymphoma response which causes the lymphoma cells to die.