Biological Therapies & NHL
One of the biological therapies used for the treatment of lymphoma is interferon therapy. Interferons are a class of proteins that are released by virus-infected cells. They help normal cells to make antiviral proteins. Interferons also help the body to reduce tumor cell proliferation (growth and reproduction), while strengthening the body's immune response.
Interferon-alpha (INFa) is a type of interferon that may be used to treat lymphoma. Research indicates that interferon can cause tumors of some NHL types to shrink. For example, interferons have been found to be active as single agents against follicular lymphoma, low-grade T-cell lymphoma, and hairy leukemia/lymphoma. Yet experts remain uncertain about the benefits of interferon, and there are questions about its suitability in combination with chemotherapy. Interferons generally are ineffective as single agents against intermediate- or high-grade lymphomas.
Interferon-alpha can be given by a number of methods - that is, by injection into a vein, into a muscle, or under the skin - although subcutaneous (under the skin) injection is the customary route. Often IFN-a is started at a low dose (e.g., 3 MU daily), with gradual increases over time.
Possible IFN-related side effects include fevers, shivers, muscle aches, bone pain, headaches, concentration difficulties, fatigue, nausea, vomiting, and general "flu-like" symptoms when starting the drug. Side effects usually last for 1 to 2 weeks, but may be lessened by drugs such as acetaminophen. They may recur if the INF-a dosage is increased, but they are temporary and usually improve after INF-a therapy is completed.
Monoclonal antibodies are laboratory-made antibodies (infection-fighting immune system proteins) that can be designed to seek and destroy lymphoma cells. These antibodies are now being tested in clinical trials with NHL patients. The monoclonal antibodies are directed against antigens (molecules that cause an immune response by antibodies) on the surfaces of lymphoma cells. Once the lymphoma cells are "tagged" by the antibodies, they are attacked and removed by the body's immune system. Monoclonal antibody therapy usually is reserved for patients with NHL that has returned or has not responded to chemotherapy.
Rituximab (Rituxan), which recognizes the antigen CD20, has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of some types of non-Hodgkin's lymphoma (e.g., relapsed or refractory low-grade lymphoma, follicular lymphoma, CD20 positive lymphoma, B-cell non-Hodgkin's lymphoma). In most cases, patients receive once weekly intravenous (IV) antibody treatments over a 4 - 8 week period.
In September 2013, the FDA approved changes to the prescribing information for Rituxan to include a new Boxed Warning about a risk of reactivation of hepatitis B virus (HBV) infection. Revisions also include recommendations for screening, monitoring, and managing patients to decrease this risk.
Ibritumomab injection (Zevalin), which attaches to cancer cells and then releases radiation to damage the cells, may be used with rituximab to treat certain types of NHL. This treatment involves first administering rituximab and then, within 4 hours, administering an infusion of ibritumomab. Over the next 48 - 72 hours, and in some cases, over the course of several days, one or more imaging scans are performed to be sure that the drugs have spread throughout the body as expected. If so, second doses of rituximab and ibritumomab injection are then administered 7 to 9 days after the first treatment.
Side effects associated with the use of antibodies may be severe and occur rapidly after the first dose. They include fever, nausea, headache, muscle and joint pain, dizziness, chills/rigidity, and others. Severe infusion reactions and hypersensitivity reactions, which are fatal in some cases, also may occur.