Jane Winter, MD & Bryan Locke, MD
Northwestern University

Each year in the U.S., approximately 90,000 people are diagnosed with lymphoma, a blood cancer of the lymph tissue. The most aggressive is large B-cell lymphoma (DLBCL.)   If chemotherapy is not effective, patients are usually given a stem cell transplant – a procedure that has unique complications and is not always a cure.

Researchers are focused on improving the effectiveness of chemotherapy on resistant cancer cells. There are some cells that have a receptor called programmed death-1 (PD-1). They survive because they are undetected by the immune system. A new drug, pidilizumab, targets this receptor and restarts the body’s ability to attack any hiding tumor cells.

This clinical trial assesses pidilizumab on patients with DLBCL after they have completed chemotherapy and who have no evidence of detectable disease on imaging scans. The goal is to destroy any hiding cancer cells and prevent the need for more aggressive chemotherapy or stem cell transplants. Drs. Winter’s and Locke’s team will monitor the immune system response with bloodwork. [Awarded 2015]

 

Clinical Summary
Each year in the US, approximately 90,000 people will be diagnosed with lymphoma, a blood cancer of the lymph tissue. Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma and can affect patients of all ages. Although a majority of patients can be cured with intense initial chemotherapy, a significant number will have the disease return. When the disease returns, patients must undergo more intense chemotherapy and often require a stem cell transplant. Effective strategies are needed to prevent the return of disease. A receptor on tumor cells called programmed death-1 (PD-1) plays an important role in hiding the tumor from our own immune system. The tumor uses this receptor to prevent the body from rejecting or destroying the tumor cells. A new drug, pidilizumab, targets this receptor and restarts the body’s ability to attack any hiding tumor cells. This class of drugs has been studied in other cancers including kidney cancer, melanoma, and lung cancer. They are well tolerated with minimal side effects. The clinical trial will investigate the use of pidilizumab for patients with DLBCL after they have completed initial chemotherapy. For those patients with no evidence of detectable disease on imaging scans, Dr. Winter’s team will enroll them for a short course of treatment with pidilizumab. The goal is to destroy any remaining lymphoma that they are unable to detect on imaging scans or labs. Blood work on the trial will allow the research team to monitor the immune system’s response to treatment. Dr. Winter’s team expects more patients to remain cured with this treatment. The therapy will therefore prevent patients from undergoing the toxicity associated with more aggressive chemotherapy and stem cell transplant. Dr. Winter’s feels this therapy represents an important step in improving the management of aggressive lymphomas.