Tuesday, October 14, 2014

Ibrutinib Combo for Follicular Lymphoma

Some say the future of lymphoma treatments won't be in finding a single "magic bullet" treatment that will wipe out the disease. Instead, recognizing that cancer involves a complex series of operations, those folks say that treatments will involve a combination of approaches. Those combinations will target several of the pathways that are necessary for cancer cells to survive.

It looks like one such combo is going to be tested.

A phase I/II clinical trial is being developed that will test the combination of Ibrutinib and Nivolumab.

We know a little something about Ibrutinib. It is a BTK Inhibitor -- that is, it stops Bruton’s tyrosine kinase, an enzyme that is necessary for cancerous B-cells to grow. It has been approved for a couple of other types of lymphoma, and is in clinical trials to see how well it might work on Follicular Lymphoma. (Early results show that it might work pretty darn well.)

For those of us in the Follicular Lymphoma family, we know less about Nivolumab. Nivolumab is one of several treatments that target PD-1, a protein found on immune cells known as T cells, which attack invaders. Cancer cells sometimes produce a substance that can bind to PD-1, shutting down the T cell, and allowing the invader (a cancer cell) to survive. Nivolumab stops that substance (which is called PD-L1) from binding to PD-1, allowing the T cells to do their job and attack the cancer cells. It's good stuff -- it's been tested on solid tumors like lung cancer, kidney cancer, and melanoma. More importantly, it received a Breakthrough Designation from the FDA for some Hodgkin's Lymphoma patients, so we have some sense that it can work on blood cancers as well.

Ibrutinib and Nivolumab will attack lymphoma cells in two different ways that seem like they will work well together. We can only hope. The trial will involve patients with several types of lymphoma, including FL. The ones that have some success will move on.

Of course, the usual warnings apply -- phase I is very early, and it's not going to work if people don't actually sign up to participate in the trial.

Definitely another one to watch. I'm guessing we'll be seeing more of these combinations in the near future.

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