TREATMENT |
TYPE
| PROS | CONS |
CONTACT |
| Allo Mini Transplant
- Patients are given immune suppressing
chemotherapy and then received a blood stem cell transplant from a matched family donor.
Patients also received
treatment to prevent graft-versus-host (GVH) disease or a graft-incompatibility reaction. |
Experimental/promising:
Lower toxicity than BMT, relies on a graft versus tumor effect of the transplant.
Main
issues is rate of donor engraftment (chimerism), the necessity and timing for infusion of
donor lymphocytes after transplant, and tumor bulk. Whether this is resulting in
lower rates of later complications (e.g. chronic GVHD) or higher response rates or even
cures are unknown.
|
Memorial
Sloan Kettering NYC, MD Anderson Cancer Center Houston, Michael
R. Bishop, MD
National Cancer Institute
Bldg. 10, Room 12N226
Bethesda, MD 20892
Phone: 301-435-2764 FAX: 301-480-4354
E-mail: mbishop@mail.nih.gov |
| anti-bcl-2 Genesense (formerly known as G3139). An
antisense therapy that inhibits expression of the bcl-2 protein, which prevents cell death and is
over expressed in many lymphomas |
Experimental/promising:
Low toxicity, does not effect other protocols. Use with other agents, such as
Rituxan, looks especially promising! |
May
work best in combination with other therapies. |
Tara Spiess
Associate Director of Operations
Corporate Communications
Two Oak Way
Berkeley Heights, New Jersey 07922
(973) 847-5905
spiess@genta.com |
| Antiangiogenesis Thalidomide, squalamine, SU5416, decoppering,
decoppering, endo/angiostatins, numerous other agents. Prevents formation of blood
vessels that support tumor growth. |
Experimental/promising:
Generally low toxicity. May enhance other therapies.
Few studies for NHL, but Thalidomide and SU5416 studies will start soon according to NCI.
Cox-2 inhibitors (such as NSAIDS) may also have antiangiogenesis properties.
New.
Little data for efficacy yet.
|
National
Cancer Institute |
| Antineoplastons naturally occurring peptides or chains of amino
acids and organic acids combined with carboxylic acids system. Usually administered with
24 hour infusion pump. |
Experimental/no
long-term toxicity: Some patients report benefit, but published results are not
available.
Quality
of life: Not without side effects, which may include stomach gas, slight rashes,
chills, fever, change in blood pressure, and unpleasant body odor during treatment.
The protocol dramatically impacts quality of life and is very expensive. Cost:
Average treatment time ranges from 4-12 months, and annual costs range from
$36,000-$60,000 depending on the type of treatment, number of consultations, and surgical
procedures necessary for insertion of catheterization devices for treatment delivery. The
oral treatment is less expensive. Cost:
Average treatment time ranges from 4-12 months, and annual costs range from
$36,000-$60,000 depending on the type of treatment, number of consultations, and surgical
procedures necessary for insertion of catheterization devices for treatment delivery. The
oral treatment is less expensive. Cost:
Average treatment time ranges from 4-12 months, and annual costs range from
$36,000-$60,000 depending on the type of treatment, number of consultations, and surgical
procedures necessary for insertion of catheterization devices for treatment delivery. The
oral treatment is less expensive. |
My
note: I do not recommend this treatment because the investigator has not yet
published results for NHL. I would like to see this, and all interesting agents,
combined with mainstream agents to identify low toxic combination treatments. This
is a lay opinion based on direct experience with the treatment and personal contact with
many patients who have tried it. |
| Arsenic trioxide (Trisenox) Therapeutic concentrations of
As2O3 (1-2 microM) had dual effects on malignant lymphocytes: 1) inhibition of growth
through adenosine triphosphate (ATP) depletion and prolongation of cell cycle time and 2)
induction of apoptosis. |
Promising/Approved/No
myelosuppression: FDA approved for the treatment of APL (a form of leukemia) in
which it has been shown to induce clinical remission with low toxicity and no
myelosuppression. It is not blocked by drug resistance so previous chemotherapy will not
reduce its efficacy and it can be used in combination with other therapies. Because Trisenox does not cause
significant myelosuppression, it
may prove beneficial as a pretreatment for vaccines and other immunotherapies.
|
At
Memorial Sloan-Kettering Cancer Center, patients with relapsed or refractory intermediate-
or high-grade NHL are being treated with arsenic
trioxide, 0.25 mg/kg/day, 5 days a week for 5 weeks. In a trial at Mount Sinai Hospital (New York, NY), patients with
relapsed or refractory low-grade NHL or CLL are eligible for treatment with arsenic
trioxide. Trial
site |
Bexxar (Tositumomab
and iodine I 131 Tositumomab)
-targets CD20 antigen on b-cells with radiolabeled isotope. |
Experimental/promising: Medium/low toxicity. High reported remission rate
published for follicular type positive for CD20. Possibility of durable remission.
Combined with CVP in some trials
See table
comparing it to Zevalin
|
Recently
approved.
Best use still under investigation
|
Phone: (415) 842-7300, or Sylvia Wheeler (415) 842-7306 Fax: (415) 842-7303
Columbia-Presbyterian Medical
Center NYC 212-746-6735 |
BMT-
(Stem Cell transplant) high dose chemotherapy/ bexxar to kill all
immune cells, followed by bone marrow implantation from previously harvested cells or
donor cells. |
Experimental/promising: Need information about remission/cure rate. |
High toxicity; can be fatal. May improve disease-free remissions. |
Center
srch: http://www2.bmtinfonet.org/centers/index.cfm
888-597-7674 |
Chemotherapy-usually
Cisplatin, CHOP, Fludarabine (FND), CVP, EPOCH, , ICE, PEPC, PROMACE. Many combination. Also used with
Rituxan and other new drugs. |
Conventional: Good first-line remission rates. Many combinations (such as
Fludarabine) available with various toxicity. Can be used with Rituxan to improve effect;
may be used with other therapies (Rituxan?) to reduce dose/toxicity. ICE is a new
combination therapy that is getting very good results. |
High Toxicity. Diminishing benefits with
retreatment. May preclude use of future immunotherapies, such as idiotype vaccines. Can cause secondary cancers.
Fludarabine, for
example, can severely diminish immune function in the bone marrow making it
difficult to
mobilize stem cells. |
Consult
NHL expert (LRFA) |
Chemotherapy, low daily oral dose
- PEP-C (Prednisone,
cyclophosphamide, etoposide, procarbazine)
|
Novel
use of conventional: Good results and low toxicity. Daily oral dose maintains
continuous serum drug levels sufficient to override at least one drug resistance mechanism.
Therapy may also be antiangiogenic. Excellent response rates for follicular, mantle
cell |
See
toxicity for chemotherapy. However, this well-tolerated treatment may be less toxic
particularly if not used for extended periods of time. |
Columbia-Presbyterian
Medical Center NYC 212-746-6735 Protocol details |
| HSP vaccine- (Oncophage) consists of autologous heat shock
protein-peptide complexes derived from the patient's own tumor |
Experimental/promising:
No data for NHL, but in theory it should work on all cancers.
Current
trial at MDACC requires resectible 4x4 cm node(s), prior treatment no longer required,
no bulky or fast growing disease. Protocol may change to allow pretreatment with
Rituxan for untreated patients.
|
MDACC, Dr. Anas Younes
Antigenics
Demo |
Idiotype vaccine
- tumor-derived vaccine used to
prevent recurrence. Many variations under study. |
Experimental/promising: Used after initial treatment has produced
sustained remission in small, but significant, study |
Not available now for patients who have been previously treated. Requires
prior chemotherapy or Rituxan |
Also
see Vaccine |
| Interferon
alpha-a protein created naturally by leucocytes
(immune cells) that has shown efficacy against lymphoma in major European studies. Other
US studies have not confirmed benefit, however. |
Experimental/promising:
Has shown efficacy in some, but not all published studies.
Cons: May
be difficult to tolerate treatment. Requires frequent injections. Different
types are available, such as Roferon (interferon alpha 2A) A new form, Pegylated
interferon, which allows once weekly injections instead of daily injections might prove
useful. May be most useful in
combination with other immunotherapies, such as Rituxan. Pegylated
version might improve dosing and reduce side effects. |
Can
be prescribe by your oncologist.
Also
see Biologics
|
| Lym-1 antibody, radiolabeled with Yttrium-90 (Y-90) |
Experimental/promising:
Treatment of all grades of non-Hodgkin’s lymphomas. Result promising for patients
who have failed other therapies |
See eligibility |
See contact
Also
see Radioimmunotherapies
|
LymphoCideTM Y-90:Yttrium-90-labeled humanized
antibody targeting CD22 receptors in B-cell lymphomas |
Experimental/promising: Treatment of indolent and aggressive
non-Hodgkin’s lymphomas. Result promising for patients who have failed other
therapies |
Requires CD22 positive tumors. May be hard to get into trials. |
Phase I/II trial using antibody labeled with yttrium-90 is being conducted at
The Garden State Cancer Center in NJ and in Europe. |
LymphoCide
(epratuzumab) Naked humanized antibody targeting CD22 receptors in B-cell
lymphomas |
Experimental/promising: Treatment
of indolent non-Hodgkin’s lymphomas. Result promising for patients who
have failed other therapies. Small phase II study indicates it may enhance
magnitude of response (more CRs) to Rituxan. Requires CD22
positive tumors.
|
Phase I/II trial using unlabeled (non-isotopic) antibody | Rituxan +
LL-2 for patients with no prior Rituxan.
Columbia-Presbyterian Medical Center NYC
212-746-6735
NCI Dr. Robert Kreitman 301-402-5633
ASCO |
PS-341
VELCADE™ (bortezomib)
thought to
interfere with the function of an important cellular protein complex, and provokes cells
to program their own destruction. |
"The
results from this study (phase I) are exciting because PS-341 was able to benefit several
patients who were not helped by standard chemotherapy," Orlowski said. PS-341 seemed
particularly active in two diseases: multiple myeloma and non-Hodgkin's lymphoma. Also
called LDP-341 |
Millenium Pharmaceuticals
mlnm.com
Also
see Emerging Treatments
|
Radiotherapy
- localized , or Central Lymphatic Radiation (CLI) is a protocol
(92-102) |
Conventional: Can cure or achieve long term remission in localized
lymphomas in some cases. For non-contiguous stage II
and stage III indolent lymphoma, central lymphatic irradiation has been proposed but is
not usually recommended as a form of treatment.16,17"
Toxicity-can cause secondary
cancers. |
MDA in a study
comparing it to Alternating Triple Therapy (ATT) to see which has better results for
indolent. So far, results have been essentially similar, so the study keeps going. They
think they may be getting as much as a 60% "cure" rate which I think they define
as a ten year remission. USC
Dept of Radiation Oncology
e-mail: thsu@hsc.usc.edu Also
see Radiotherapy |
Rituxan
- monoclonal antibody that binds to CD20
positive lymphoma cells and induces cell lysis (death) |
Approved
Immunotherapy: Low toxicity in most pts, may not effect other protocols,
enhances CHOP, may be used more than once. Best results for follicular NHL.
Rituxan
can be used repeatedly. Remarkably, some of these subsequent remissions have
latest longer than the first remission.
|
IDEC- (619) 550-8500 See
Rituxan for details |
Thalidomide
- angiogenesis and immune enhancing New
versions under investigation. |
Experimental/unproven: Moderate toxicity. My Note: May be a good to try
during watch & wait. Can be prescribed now, although not approved for NHL. |
Unproven. May cause neuropathy if used over a long period of time. Requires
special permission (see STEPS). |
To
register in STEPS, please
call 1-888-4-235436 Web info from Celgene Also
see Emerging Treatments |
| Vecade
- See |
Thought to
interfere with the function of an important cellular protein complex, and provokes cells
to program their own destruction. "The
results from this study (phase I) are exciting because PS-341 was able to benefit several
patients who were not helped by standard chemotherapy," Orlowski said. PS-341 seemed
particularly active in two diseases: multiple myeloma and non-Hodgkin's lymphoma. Also
called LDP-341 |
|
|
Zevalin- monoclonal
antibody that targets the CD20 antigen and is stably linked to the radioisotope 90Yttrium.
|
Recently
approved: Medium/low toxicity. High reported remission rate
published for follicular type positive for CD20. Possibility of durable remission. |
Unknown long-term toxicity.
Recently approved
(See table
comparing it to Bexxar) |
IDEC- (619) 550-8500 Also
see Radioimmunotherapies |
