What is targeted therapy for lymphoma?

  Targeted therapy is a revolutionary advancement in the treatment of lymphoma. In addition to conventional chemotherapy and hematopoietic stem cell transplantation, the most notable advancement is the targeted therapy for lymphoma. Compared with traditional cytotoxic drugs, targeted therapy targets the altered characteristics of tumor cells to exert stronger anti-tumor activity while reducing the toxic side effects on normal cells.  Targeted therapies currently used in lymphoma are mainly chimeric, humanized antibodies produced by genetic engineering technology. A crucial aspect of targeted therapy with monoclonal antibodies is the selection of antigens. The ideal target antigen should be a tumor-specific antigen, expressed only in tumor cells and not or rarely expressed in normal cells, and the target antigen should be expressed stably and uniformly in tumor cells without producing secretory antigens, avoiding antibody binding to and clearance of antigens in the blood circulation; the ideal target antigen should be involved in the regulation of apoptosis or cell growth signals, and antibody binding to antigen can block tumor cell growth, induce apoptosis, and increase the sensitivity of tumor cells to chemotherapy or other treatments. Antibody binding to antigen inhibits and destroys tumors by activating immune effects such as complement-dependent cytotoxic effects (CDC), antibody-dependent cellular cytotoxic effects (ADCC), and, more importantly, by modulating effects or inducing apoptosis and inhibiting cell growth signaling.  Anti-CD20 monoclonal antibody CD20 antigen is a good immunotherapeutic target for lymphoma and is present only in malignant B cells and mature B lymphocytes. Once the antigen-antibody binds, there is no significant shedding, internalization or modulation of the antigen. Meroval (Rituximab) was the first humanized anti-CD20 monoclonal antibody to be used in the clinic and is the most widely and intensively studied.  The clinical indications for meloval are relapsed low-grade malignant NHL and combination with chemotherapy for inert, aggressive NHL. Meloval may have synergistic effects in combination with other immunomodulatory agents, such as interferon and GM-CSF, and preclinical studies suggest that CD20 expression may be upregulated thereby increasing the antitumor activity of meloval. In addition, preliminary studies have found that cytokines such as IL-2 and IL-12 have synergistic effects with melphalan.  Proteasome inhibitors In addition to monoclonal antibodies, other targeted therapeutic agents have also made progress in the treatment of lymphoma, such as proteasome inhibitors. Proteasome plays an important role in cell cycle regulation and is therefore one of the targets of antitumor therapy. The first proteasome inhibitor was Velcade. Preclinical studies have shown that Vanco inhibits proteasome activity in a variety of B-cell malignancies (e.g., multiple myeloma, diffuse large B-cell NHL, condylomatous NHL, HD, etc.), promotes apoptosis, and increases the sensitivity of tumor cells to chemotherapy and radiotherapy.  The disadvantages of monoclonal antibody therapy include altered expression of target antigens; reversible binding of antigen-antibody; difficulty in reaching tumor tissue when large masses or tumors have poor blood supply; and clearance of antibodies due to large amounts of free target antigens in the circulating pool.  In conclusion, lymphoma-targeted therapy, especially humanized CD20 monoclonal antibody and Vanco, is the current hot spot in lymphoma treatment research, and has gradually become the standard treatment for B-cell NHL, which will increase the cure rate of NHL to a higher level with the accumulation of treatment experience.