According to a recent article published in an early online addition of The Journal of Clinical Oncology, the monoclonal antibody epratuzumab (humanized anti-CD 22 monoclonal antibody) appears to provide long-term activity in patients with recurrent follicular lymphoma.

Non-hodgkin's Lymphoma (NHL) is a form of cancer that begins in the cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes and circulating immune cells. The main cells in the lymph system are lymphocytes, of which there are two types: B and T-cells. Each of these cells has a very specific function in aiding the body to fight infection. NHL is characterized by the excessive accumulation of atypical (cancerous) lymphocytes. These lymphocytes can crowd the lymph system and suppress the formation and function of other immune and blood cells. While NHL is categorized by the type of lymphocyte it involves, it is also further defined by the rate at which the cancer grows, based on the appearance of the cells under a microscope. High-grade or aggressive NHL is the fastest growing and low-grade or indolent lymphoma is the slowest growing. Follicular lymphoma is considered an indolent lymphoma, but can transform to a more aggressive lymphoma, referred to as transformed B-cell lymphoma. Recurrent follicular lymphoma is cancer that has returned following therapy and refractory follicular lymphoma is cancer that has stopped responding to standard therapies. Researchers are evaluating newer biological therapies, types of treatment that help utilize the patient’s own immune system to fight the cancer, for patients with refractory follicular lymphoma.

One type of biological therapy involve monoclonal antibodies. Monoclonal antibodies are proteins and/or carbohydrates that can be modified and produced through laboratory processes. They are developed so that they can bind to very specific components of cells, called antigens. Specific antigens can be found on different types of cells, so that monoclonal antibodies can be designed to target individual types of cells in the body. Epratuzumab has been designed to bind to an antigen called the CD 22 antigen, which is found on B lymphocytes, the type of cell that is cancerous in follicular NHL. This binding action produces several responses within the cell and body which ultimately provide anti-cancer activity, including the initiation of an immune response to discard the cancerous B lymphocyte to which epratuzumab is bound. Epratuzumab is currently in clinical trials for the treatment of indolent NHL.

Researchers from New York recently conducted a clinical trial to evaluate epratuzumab in the treatment of indolent NHL. This trial involved 51 patients, over half of whom had received at least 4 prior treatment regimens. Patients were divided into two groups – one group received a lower dose of epratuzumab than the other group. Among all patients, only those with follicular NHL responded to treatment with epratuzumab. Among patients with follicular NHL, 43% of patients achieved an anti-cancer response in the group of patients treated at the lower dose, and 27% of patients achieved an anti-cancer response in the group treated at the higher dose. The average time to cancer progression among the patients who responded was nearly 90 weeks. Treatment was well tolerated, even at the higher doses.

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The researchers concluded that epratuzumab is an effective treatment option for patients with recurrent follicular NHL, even for those who have received extensive prior therapy. Furthermore, epratuzumab provided durable, long-lasting anti-cancer activity in patients who responded. Patients with recurrent follicular NHL may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating epratuzumab or other promising therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Cancerconsultants.com also provides personalized clinical trial searches on behalf of patients.

Reference: Leonard J, Coleman M, Ketas J, et al. Phase I/II Trial of Epratuzumab (Humanized Anti-CD22 Antibody) in Indolent Non-Hodgkin's Lymphoma.

The Journal of Clinical Oncology. Early online publication. Available at: http://www.jco.org/cgi/content/abstract/JCO.2003.01.082v1. Accessed July 18, 2003.

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