Targeted therapy for non-Hodgkin lymphoma

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells. Targeted therapy may also be called molecular targeted therapy.

Targeted therapy is usually used to treat non-Hodgkin lymphoma (NHL). You may have targeted therapy to:

• lower the risk that cancer will come back (relapse)
• treat NHL with certain genetic mutations
• treat NHL that expresses certain proteins
• help chemotherapy to work better
• treat NHL that doesn't respond to chemotherapy or comes back after other treatments

If you have targeted therapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules. The type of targeted therapy you may be given for NHL will depend on the proteins (also called receptors) on the NHL cells. Cell and tissue studies are used to identify these proteins.

Side effects of targeted therapy will depend mainly on the type of drug or combination of drugs, the dose, how it's given and your overall health. Tell your healthcare team if you have side effects that you think are from targeted therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

The following are different types of targeted therapy that can be used to treat NHL. Specific drugs may not be covered by all provincial or territorial health plans.

The monoclonal antibodies used to treat NHL have been designed in a lab to recognize and lock onto specific proteins or receptors on the surface of some NHL cells. Then they stimulate the body's immune system to attack and destroy the cell it attaches to.

Monoclonal antibodies can be used alone or with chemotherapy or other targeted therapy drugs. They may be used as the first-line therapy for NHL that comes back after it was treated (called relapsed NHL). They can also be used if NHL doesn't respond to treatment (called refractory NHL).

Rituximab (Rituxan and biosimilars) target the CD20 protein on the surface of B cells. It is the most common targeted therapy drug used to treat NHL, and it is used for many different types of B-cell NHL. It is often combined with chemotherapy, but it can also be used by itself.

Other types of monoclonal antibodies that are used to treat NHL include the following:

• Obinutuzumab (Gazyva) targets the CD20 protein.
• Brentuximab vedotin (Adcetris) targets the CD30 protein.
• Polatuzumab vedotin (Polivy) targets the CD79b protein.
• Tafasitamab (Minjuvi) targets the CD19 protein.
• Mogamulizumab (Poteligeo) targets the CC4 receptor on NHL cells.

Monoclonal antibodies may cause these side effects:

• low blood cell counts
• flu-like symptoms, like fever and chills
• nausea and vomiting
• constipation
• tumour lysis syndrome
• peripheral nerve damage
• fatigue
• cough
• infection

Bruton's tyrosine kinase (BTK) inhibitors are a type of tyrosine kinase inhibitor. Tyrosine kinases are a part of a protein that acts like a cell's on and off switch. They are enzymes that play an important role in a cell's growth and division. Tyrosine kinase inhibitors block these enzymes from sending signals that cause a cancer cell to grow.

BTK inhibitors may be used alone or in combination with chemotherapy or other targeted therapy drugs.

The following BTK inhibitors may be used to treat different types of NHL:

• acalabrutinib (Calquence)
• ibrutinib (Imbruvica)
• zanubrutinib (Brukinsa)

BTK inhibitors may cause these side effects:

• diarrhea
• low blood cell counts
• infection
• bleeding
• heart problems
• flu-like symptoms, such as chills and fever
• fatigue
• cough
• nausea and vomiting
• skin problems, such as a rash
• headache
• pain, such as joint pain and stiffness
• liver problems
• kidney problems
• tumour lysis syndrome

Histone deacetylase (HDAC) is an enzyme that can make cancer cells grow. HDAC inhibitors are targeted therapy drugs that block the actions of HDAC to slow or stop the growth of cancer cells.

Vorinostat (Zolinza) is a HDAC inhibitor that may be used to treat skin lymphomas.

Vorinostat may cause these side effects:

• fatigue
• diarrhea
• nausea and vomiting
• taste changes
• low blood cell counts
• weight loss
• loss of appetite

Immunomodulatory drugs block the growth and division of cancer cells. The ones used to treat NHL work by stopping tumours from developing new blood vessels, which they need to grow and survive. They are called anti-angiogenesis drugs. They are given as a capsule taken by mouth.

Lenalidomide (Revlimid) is a drug that may be used to treat some types of NHL.

Lenalidomide may cause these side effects:

• low blood cell counts
• skin problems, such as itching, rash and dry skin
• diarrhea
• nausea and vomiting
• constipation
• fatigue
• swelling (called edema)
• infection
• headaches

Find out more about targeted therapy. To make the decisions that are right for you, ask your healthcare team questions about targeted therapy.

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.