Non-Hodgkin lymphoma (NHL) isn’t a single disease, but rather a large group of blood cancers including about 60 different subtypes. These subtypes can either be aggressive or indolent (slow-growing), requiring different treatment approaches based on its rate of growth and a few other factors. When it comes to the slow-growing subtypes of NHL, the most common is follicular lymphoma (FL). Although follicular lymphoma can be managed, it often comes back, making it hard for patients to go into remission. Because of this, the need for new treatments and further research is ongoing.
What is Follicular Lymphoma?
Non-Hodgkin lymphomas affect either the B-cells or the T-cells – both white blood cells called lymphocytes. B-cells produce antibodies which help your body fight infections, protecting your body from harmful bacteria, viruses or parasites. Follicular lymphoma develops in the lymph nodes or the bone marrow when white blood cells cluster together to form lumps in your lymph glands or organs. About 11% of all non-Hodgkin lymphomas are follicular lymphoma.
If left untreated this type of lymphoma can transform into diffuse large B-cell lymphoma, a more difficult type of lymphoma to treat.
Standard Treatments for Follicular Lymphoma
Due to the slow progression of follicular lymphoma, treatment isn’t always recommended right away. However it’s important to be under a doctor’s care. In most cases you will be seen by a hematologist who is also an oncologist.
Watchful waiting is a common approach for slow-growing lymphomas that pose no immediate threat to the patient. However, if the lymphomas is found at a more advanced stage, waiting may not be recommended. Learn more about NHL staging.
Once treatment begins there are several approaches used. Many patients receive more than one of the following:
Radiation therapy. Radiotherapy uses high-energy rays to kill lymphoma cells. While radiation isn’t always an option for lymphoma patients, it is for follicular lymphoma because the cancer cells are bunched together and can be targeted with beams of radiation.
Chemotherapy. These are drugs that kill lymphoma cells throughout the body. Because the drugs travel through the bloodstream and can reach lymphoma cells in almost all parts of the body, it is called systemic therapy.
Targeted therapy. This uses drugs or other substances to identify and attack specific cancer cells. Monoclonal antibody therapy, kinase inhibitor therapy, and immunomodulatory drugs are types of targeted therapy that may be used to treat follicular lymphoma.
Immunotherapy. Immunotherapy, also called biologic therapy, helps the patient’s immune system fight cancer. CAR T therapy and checkpoint inhibitors are common types of immunotherapies to treat FL and other subtypes of NHL.
Up until recently, patients with follicular lymphoma only had the option of receiving one or a combination of the above treatments. Unfortunately, it only managed, not cured, this complex disease. Fortunately, because of continuous immunotherapy clinical research, a new option is available to help these patients.
Lunsumio: An Additional Treatment Option for Advanced Follicular Lymphoma
Lunsumio® (mosunetuzumab) is a new immunotherapy recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced follicular lymphoma. The drug is approved to treat patients whose follicular lymphoma has returned or worsened despite undergoing at least two earlier treatments. Lunsumio is the first bispecific antibody, a type of immunotherapy, approved to treat any type of non-Hodgkin lymphoma.
Prior to this approval, patients who experienced a recurrence of their follicular lymphoma, or those who did not respond to previous treatment, had limited treatment options. Now, patients living with this hard-to-treat lymphoma have a true chance at achieving remission.
Lunsumio was used in clinical trials on patients with advanced follicular lymphoma. These were patients whose cancer did not respond to two or more previous lines of treatment. Studies in these trials, conducted by The American Society of Hematology, showed 80 percent of patients responded favorably to Lunsumio and that 60 percent of patients experienced complete remission.
Current treatments for non-Hodgkin lymphomas, such as CAR T immunotherapy, and other targeted therapies work on only a single target. Lunsumio, on the other hand, is a bispecific antibody immunotherapy, meaning it involves dual targeting. Lunsumio attaches to both the surface of the B cells and to special immune cells called T cells. The T cells are then engaged to destroy the cancer cells.
Patients with advanced follicular lymphoma can expect to receive Lunsumio as an infusion in an outpatient setting. It is administered once a week for the first three weeks, then once every three weeks. Unlike other immunotherapies that need to be developed for the individual patient, Lunsumio does not need to be personalized. This makes it very accessible to patients, allowing them to start treatment faster than in the past.
As with other types of lymphoma treatments, patients receiving Lunsumio may experience certain side effects. With Lunsumio, a side effect that may occur is Cytokine Release Syndrome (CRS). CRS can produce symptoms ranging from mild to severe. Signs and symptoms of CRS can include:
Fever and chills
Low blood pressure
Fast or irregular heartbeat
Fatigue or weakness
Nausea and/or vomiting
Dizziness or lightheadedness
Patients who experience any of these symptoms should contact their cancer care team immediately. Your hematologist oncologist may temporarily stop or completely stop your treatment with Lunsumio, especially if your symptoms are severe.
Lunsumio Treatment Available at Compass Oncology for Patients With Advanced Follicular Lymphoma in Portland-Vancouver
While the hematologists at Compass Oncology care for people with all types of lymphomas, we encourage patients whose follicular lymphoma has returned or been unresponsive to previous non-Hodgkin lymphoma treatments to reach out for a consultation regarding the possible use of Lunsumio. The Compass Oncology hematology department also provides second opinions so you can feel confident about this new and promising therapy for advanced follicular lymphoma and other types of lymphoma.
Compass Oncology is here to help. If you're in the Portland-Vancouver area, request an appointment to learn more about our collaborative approach to blood cancer care. All of our Hodgkin and non-Hodgkin lymphoma treatments, including Lunsumio, can be administered close to home at one of our convenient locations.