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Targeted therapy for childhood non-Hodgkin lymphoma
Targeted therapy is sometimes used to treat certain types of childhood non-Hodgkin lymphoma (NHL). It uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells. Targeted therapy may also be called molecular targeted therapy.
Your child may have targeted therapy to treat:
- Burkitt lymphoma or diffuse large B-cell lymphoma (DLBCL)
- childhood NHL that no longer responds to chemotherapy
Your child’s healthcare team will consider the child’s personal needs to plan the drugs, doses and schedules of targeted therapy. Your child may also receive other treatments.
Targeted therapy drugs used for childhood NHL
The main targeted therapy drug used to treat childhood NHL is rituximab (Rituxan), which is used for newly diagnosed DLBCL and Burkitt lymphoma. Other targeted therapy drugs, such as brentuximab vedotin (Adcetris) and crizotinib (Xalkori), may be used in some relapsed cases in a clinical trial setting. CAR T-cell therapy may also be used in a clinical trial setting.
Both rituximab and brentuximab vedotin are monoclonal antibodies. These drugs are designed to attach to a specific substance (protein marker) on the surface of lymphoma cells.
Rituximab is designed to attach to CD20, which is one of the most common protein markers on lymphoma cells. CD20 is found on normal and abnormal B cells (B lymphocytes). Abnormal B cells are associated with some types of childhood NHL. Rituximab works by stimulating the body’s immune system to attack and destroy the lymphocytes it attaches to. This drug is used to treat certain types of B-cell NHL that have CD20 (called CD20-positive, or CD20+, NHL), such as Burkitt lymphoma and DLBCL. CD20 is not usually found on B cells in lymphoblastic lymphoma.
Brentuximab vedotin targets CD30, which is another protein that may be found on the surface of some lymphoma cells. This drug may be used to treat anaplastic large cell lymphoma (ALCL) that has come back (recurred) after other treatments.
New monoclonal antibodies (called immune checkpoint inhibitors) may be used in combination with other therapies in relapsed or recurrent childhood NHL in a clinical trial setting.
Crizotinib and ceritinib (Zykadia) target ALCL cells that have an abnormal anaplastic lymphoma kinase (ALK) gene (called ALK-positive ALCL). Crizotinib may be used to treat ALK-positive ALCL that is no longer responding to other treatments.
Side effects can happen with any type of treatment for childhood NHL, but every child’s experience is different. Some children have many side effects. Other children have only a few side effects.
Side effects can happen any time during, immediately after or a few days or weeks after targeted therapy. Sometimes late side effects develop months or years after targeted therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of targeted therapy will depend mainly on the type of drug or combination of drugs, the dose, how it’s given and your child’s overall health. Some common side effects of targeted therapy for childhood NHL are:
- flu-like symptoms, such as chills, fever, nausea, fatigue, skin rash and headache
- nausea and vomiting
- changes in blood pressure
- bone marrow suppression
- peripheral nerve damage
Other side effects can develop months or years after treatment for childhood NHL. Find out more about late effects for childhood NHL.
Tell your child’s healthcare team if your child has these side effects or others you think might be from targeted therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.
Information about specific cancer drugs
Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.
Questions to ask about targeted therapy
A substance that can find and bind to a particular target molecule (antigen) on a cancer cell.
Monoclonal antibodies can interfere with a cell’s function or can be used to carry drugs, toxins or radioactive material directly to a tumour.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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