According to a recent article published in the Journal of Clinical Oncology, Velcade® (bortezomib) demonstrates promising anti-cancer activity in the treatment of non-Hodgkin’s lymphoma that has stopped responding to standard therapies, particularly mantle cell 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. Once NHL recurs following initial therapy or stops responding to standard therapies (refractory), patients are left with limited options.

Velcade® is classified as a proteosome inhibitor and has been approved with the United States Food and Drug Administration (FDA) for the treatment of multiple myeloma that has progressed or returned following previous therapy. Proteosomes are proteins existent in virtually every cell that are responsible for the breakdown and re-use of other proteins in a cell. In addition to inhibiting protesome activity within a cell, Velcade® has demonstrated an anti-cancer effect on several proteins that regulate cellular growth and replication by either inhibiting or facilitating progression of numerous biological pathways. Velcade® is being evaluated in clinical trials for the treatment of several types of cancers, including NHL.

Researchers from the University of Texas M.D. Anderson Cancer Center recently conducted a clinical trial to evaluate Velcade® in the treatment of patients with refractory B-cell NHL. The trial included two separate groups: the first group (group A) included 33 patients with refractory mantle cell NHL, and the second group (group B) included 27 patients with several types of refractory NHL, including diffuse large B-cell lymphomas, follicular lymphomas, small lymphocytic lymphomas, Waldenstrom’s macroglobulinermias and marginal zone lymphoma. Overall, patients had received an average of 3.5 prior treatment regimens for their disease. The overall anti-cancer response rate was 41% in group A and 19% in group B. At over 9 months of follow-up, the average time to cancer progression had not yet been reached in group A. The most common serious side effects were low levels of blood cells, gastrointestinal side effects, fatigue and numbness or tingling of the hands or feet.

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The researchers concluded that Velcade® provides anti-cancer responses in patients with refractory NHL and appears particularly active in mantle cell lymphoma. Velcade® could provide a treatment option for this group of patients who are left with limited effective standard therapies. Patients with refractory NHL may wish to speak with their physician regarding the risks and benefits of participating in a clinical trial further evaluating Velcade® or other promising treatment options. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches are also performed on behalf of patients at cancerconsultants.com.

Reference: Goy A, Younes A, McLaughlin P, et al. Phase II Study of Proteasome Inhibitor Bortezomib in Relapsed or Refractory B-Cell Non-Hodgkin’s Lymphoma. Journal of Clinical Oncology. 2005; 23: 667-675.

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