If Your Lymphoma Immunotherapy Doesn’t Work

If you or someone you love has lymphoma, your doctor may suggest immunotherapy. This newer type of cancer treatment powers up, or adds to, your immune system so it can better kill cancer cells.

It doesn’t work for everyone. How well immunotherapy works “depends on the type of lymphoma you have,” says Jack Jacoub, MD, a medical oncologist and medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, CA.

There are six types of Hodgkin's lymphoma (HL) and more than 90 types of non-Hodgkin's lymphoma (NHL). Some types of lymphoma have been found to respond better to immunotherapy than others.

If you have one of the lymphoma types that immunotherapy is good at fighting, and are otherwise in good health, Jacoub says “there’s a good chance” that you’ll do well with this treatment.

If it doesn’t work out, you still have other options.

When Will You Know?

Unlike chemotherapy, “immunotherapy treatments do not generally work rapidly,” says Sean Fischer, MD, a medical oncologist and hematologist at Providence Saint John’s Health Center in Santa Monica, CA.

It may take several months of treatment before your doctor can make that call.

Your doctor will take into account any side effects that you have. These can show up early on or late into your treatment. While often not as intense as those you have with chemo, there are times when those side effects “can be quite serious and even fatal if not recognized,” Fischer says.

For instance, some people start to have severe problems with their lungs, brain, colon, kidneys, or liver. If your doctor can’t control the side effects that you have, you may also need to stop your immunotherapy.

What Else Can You Try?

If your current immunotherapy doesn’t work or causes serious health problems, you and your doctor can talk about other options, which may include:

A clinical trial . These are research studies that test new treatments that may not yet be available to the public. “There are currently many ongoing clinical trials attempting to address resistance to immunotherapy,” Fischer says. For instance, some trials may combine immunotherapy with “targeted therapies” -- drugs that block the growth of cancer -- to help immunotherapy work better. Your oncologist can help you look for a clinical trial that you might be able to join, and to find out what’s involved.

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Chimeric antigen receptor (CAR) T-cell therapy. This is a different type of immunotherapy. “It’s an entirely different way of engaging the immune system,” Jacoub says. 

For this treatment, you get some blood taken out, and a lab sifts through it for special immune cells called T cells. The lab tweaks those T cells so they have tiny receptors, called “CARs,” to help them seek out and attack lymphoma cells. You then get a lot of those CAR T cells put back into your blood, so that they go to work against your cancer.

The FDA has approved one CAR T-cell therapy to treat some kinds of large B-cell lymphoma. Researchers are studying others in clinical trials.

A lower dose. This may not be the solution, but it’s something your doctor may look into. “Typically, dose reductions make little difference with immunotherapy,” Jacoub says. But if your treatment seems to making some progress and side effects are the main problem, delaying or dropping a treatment dose could help.

Other types of treatment. This could include high-dose chemotherapy (and sometimes radiation) to kill the cancer cells in your body, followed by a stem cell transplant. “There are times when chemo is more effective than immunotherapy,” says Eric D. Jacobsen, MD, a senior doctor at the Dana-Farber Cancer Institute. This may be a good plan if you have non-Hodgkin's lymphoma.

If you’re thinking of trying alternative treatments, like herbs or a special diet, talk to your doctor first. You need to know what’s safe to try and what the research shows. Be very wary of anything that promises a cure, and remember that even “natural” products have risks. A better plan might be to talk to your doctor about adding “complementary” or “integrative” approaches that help you feel better during your regular medical care. These may include acupuncture, meditation, massage, and nutrition.

WebMD Feature Reviewed by Laura J. Martin, MD on May 20, 2018

Sources

SOURCES:

Sean Fischer, MD, medical oncologist and hematologist, Providence Saint John’s Health Center, Santa Monica, CA.

Jack Jacoub, MD, medical oncologist and medical director, MemorialCare Cancer Institute at Orange Coast Medical Center, Fountain Valley, CA.

Eric D. Jacobsen, MD, clinical director, Adult Lymphoma program and senior doctor, Dana-Farber Cancer Institute, Boston.

American Cancer Society: “Immunotherapy for Non-Hodgkin Lymphoma,” “Non-Hodgkin Lymphoma.”

Expert Review of Hematology: “Immunotherapy for the treatment of Hodgkin lymphoma.”

Lymphoma Research Foundation: “What is Lymphoma?”

Cancer. Net: “What You Need to Know About Immunotherapy Side Effects.”

Dana-Farber Cancer Institute: “What is a PD-L1 Test?”

Institute of Clinical Immuno-Oncology: “Recognizing and Managing Immune-Specific Adverse Events.”

Cancer Treatment Centers of America: “Why does immunotherapy work for some but not others?”

Cancer Research Institute: “Immunotherapy for Lymphoma.”

National Cancer Institute: “Targeted Cancer Therapies,” “What are Clinical Trials?”

National Center for Complementary and Alternative Medicine: “Thinking About Complementary & Alternative Medicine.”

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