People with an aggressive form of blood cancer have been given new hope as two new drugs are set to come onto the NHS.
The drugs, epcoritamab and loncastuximab tesirine, were approved by the NHS spending watchdog within two days of each other, providing a lifeline for patients with a type of non-Hodgkin’s lymphoma that kills four in 10 people within five years of diagnosis.
Around 5,500 Britons are diagnosed with diffuse large B-cell lymphoma (DLBCL) every year. The condition occurs when some of the body’s immune cells, known as lymphocytes, do not work properly and build up in the lymph nodes or other parts of the body. It usually manifests as swollen glands in the neck, unexplained weight loss, night sweats and painless lumps on the body.
Following the drugs’ approval, NHS doctors can now give DLBCL patients epcoritamab or loncastuximab tesirine if their cancer has not responded to at least two other treatments.
Diffuse large B-cell lymphoma occurs when some of the body’s immune cells, known as lymphocytes, do not work properly and build up in the lymph nodes or other parts of the body (stock photo)
Epcoritamab, sold under the brand name Tepkinly, is administered via monthly injections. It is a so-called bispecific antibody: a protein that recognizes and attaches to cancer cells, allowing the body to fight the disease
However, Loncastuximab tesirine is an antibody-drug conjugate, given through an infusion, and works by detecting proteins on the surface of cancer cells and delivering chemotherapy to the tumor to kill it.
Epcoritamab, sold under the brand name Tepkinly, is administered via monthly injections. It is a so-called bispecific antibody: a protein that recognizes and attaches to cancer cells, allowing the body to fight the disease.
One study found that 39 percent of patients who received the treatment were cancer-free after just ten months.
However, Loncastuximab tesirine is an antibody-drug conjugate, given through an infusion, and works by detecting proteins on the surface of cancer cells and delivering chemotherapy to the tumor to kill it.
Dr. Dima El-Sharkawi, a consultant hematologist at London’s Royal Marsden NHS Foundation Trust, says the drugs could provide a solution for a fifth of people with DLBCL for whom no other treatment has worked.
The outlook for these patients is bleak and they often die within a few months. The standard treatment for DLBCL is known as R-CHOP – a combination of chemotherapy and an immune-boosting cancer treatment called immunotherapy, which trains the body to ward off cancer.
This currently cures around half of DLBCL patients, but the remaining patients must seek alternative options such as a stem cell transplant – formerly known as bone marrow transplant.
This procedure involves harvesting the patient’s or a donor’s stem cells from the bone marrow – the spongy tissue in our bones that is responsible for producing red blood cells and white blood cells of the immune system.
These are multiplied in a laboratory before being injected into the patient, in the hope that they will prevent the body from producing the defective white blood cells that characterize blood cancers such as DLBCL.
More recently, patients have been offered CAR-T therapy, which modifies cells in the immune system to target and attack cancer cells.
However, some people are too weak to cope with the side effects – including breathing problems, fever, low blood pressure and vomiting – and about half of patients who choose the treatment see their cancer come back.
Dr. El-Sharkawi says: ‘There has been an explosion in terms of treatment options for DLBCL. All you need for each patient is for just one of these drugs to work.”
Alexander Gudmestad, 34, first received his ‘devastating’ DLBCL diagnosis in the spring of 2020 in his native Norway after discovering several lumps in his neck.
The filmmaker, who now lives with his wife Lottie in Reigate, Surrey, said: ‘I thought it was probably a cold but the lumps kept growing. I had testicular cancer as a child, so I knew I had to go to the doctor quickly.’
Alexander’s doctors in Norway began treating him with R-CHOP, with initial success, but the cancer returned the following year. He underwent several more rounds of treatment, including more chemotherapy and a stem cell transplant, but the cancer kept returning.
In 2022, Alexander moved to England and underwent CAR-T therapy on the NHS at the Royal Marsden Hospital NHS Trust. The cancer returned later that year and Alexander started epcoritamab in October.
He adds, “We didn’t know if it would work, so I didn’t want to get my hopes up.”
But a scan last month revealed the ‘really good news’ that the treatment is working and Alexander is now cancer-free.
“I am very happy that it is working and I will continue the treatment as long as it works,” he adds. ‘I can live quite normally with the disease and the treatment as long as it works, which was not an option before.
“If I had been in the same situation two years ago, there would have been no hope.”