Onkológia 3/2019

Checkpoint inhibitors in treatment of malignant lymphoma

Targeted treatment of cancer has added a new promising option to standardly used chemotherapeutic regimens. Several types of monoclonal antibodies have already proven reduction of morbidity and mortality. Closer insight into the function of tumor microenvironment, ongoing immunoregulatory pathways and elucidation of tumor cell evasion mechanisms from immune response has led to the discovery of checkpoint inhibitors (CPI). Their main role is to enhance anti-tumor imunity, since the tumor cell is able to dampen the host‘s immune system and thus evade elimination. CPI achieved very good responses in treatment of metastatic malignant melanoma, which was also the first indication approved by Food and Drug Administration (FDA) in 2011. Consequently, they seem to be a good treatment option in other advanced cancer types such as non-small cell lung cancer, kidney cancer, bladder cancer, epidermoid head and neck cancer, some types of colorectal cancer and others. In case of hematological malignancies CPI showed a good efficacy in classical Hodgkin‘s lymphoma (cHL), which led to the approval of nivolumab by FDA in 2016 in heavily pretreated patients with cHL. Treatment responses have also been reported in some subtypes of diffuse large B-cell lymphoma, follicular lymphoma, and T-cell lymphomas. This review describes the mechanism of action of CPI, an overview of selected studies evaluating the effect of treatment and toxicity in specific types of lymphoma, the position of CPI in cHL patients before/after allogeneic transplantation.

Keywords: malignant lymphoma, checkpoint inhibitors, anti-cancer immune response