We now know that not only do different types of lymphoma behave differently, but that every person’s cancer is unique. What is more, different areas of lymphoma in the same person can have different mutations (genetic changes that make the cells behave abnormally).
The aim of precision medicine is to match the right treatment to the features of each person’s lymphoma. It is still early days but haematology research (studying lymphoma and other blood disorders) is leading the way in precision medicine.
It is challenging to design clinical trials that can identify people for certain treatments but it is possible. The ReMODL-B trial didn’t succeed in its aim of improving treatment for a subgroup of people with diffuse large B-cell lymphoma (DLBCL) - but it did show that it is possible to find genetic changes in lymphoma cells quickly enough for this information to be used in treatment decisions.
ReMODL-B was a clinical trial that tested whether certain types of diffuse large B-cell lymphoma (DLBCL) responded better to adding a targeted drug called ‘bortezomib’ to standard treatment. To do this, researchers looked at the genes of each person’s lymphoma cells to decide what type of DLBCL they had: activated B-cell (ABC) or germinal centre B-cell (GCB). People with ABC-type DLBCL have been reported to have a worse outcome than people with GCB-type DLBCL.
Adding bortezomib didn’t improve the outcome for either group. However, researchers were able to complete the tests to find out what type of DLBCL each person had for the majority of people before treatment started. Current and future trials can build on this approach to identify treatments that work well for people with certain gene changes.
With thanks to Dr Andrew McMillan, Consultant Haematologist, Nottingham University Hospitals NHS Trust for reviewing this article.
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