Magazine article Drug Topics

NCCN Updates Non-Hodgkin's Lymphoma Guides

Magazine article Drug Topics

NCCN Updates Non-Hodgkin's Lymphoma Guides

Article excerpt

The National Comprehensive Cancer Network (NCCN) recently updated its guidelines for non-Hodgkin's lymphoma (NHL) to include new therapeutic options, as well as changes to diagnostic criteria and staging. NHL encompasses a large group of cancers of the immune system that can strike at almost any age. Generally speaking, NHL is much less predictable than Hodgkins lymphoma and has a higher tendency to disseminate to extranodal sites.

NHL has been one of the most rapidly increasing types of cancer in the past few decades, and it is estimated that more than 63,000 new cases of NHL will be diagnosed in the United States in 2007. The increase is only partly explained by the concomitant development of NHL in the setting of HIV infection. Although NHL can manifest as several different types, it is generally classified as either T-cell or B-cell NHL.

The more common type, B-cell NHL, includes Burkitt's lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell NHLs include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Prognosis and treatment of NHL depend on the stage and type of disease.

The updated guidelines from NCCN include new recommendations for peripheral T-cell lymphomas (TCEL-1)-particularly aggressive NHLs. In addition, the NCCN panel added guidelines for mycosis fungoides and Sezary syndrome, which are otherwise known as cutaneous T-cell lymphomas (CTCLs). Cutaneous disease typically progresses from an indolent eczematous patch covering less than 10% of the body surface to severe tumors that undergo necrotic ulceration and subsequent generalized erythroderma. Patients with stage III through stage IV CTCL disease have a median survival of less than five years.

Fortunately, however, CTCL patients now have a new treatment option available with the approval of Merck's vorinostat (Zolinza). Vorinostat is a member of a relatively new class of agents known as the histone deacetylase (HDAC) inhibitors, which modulate the expression of genes by causing an increase in histone acetylation and ultimately induce cancer cell death. Interestingly, the well-known antiepileptic drug valproic acid (WA) has also been shown to be a class I selective HDAC inhibitor, and there have been some recent studies to evaluate its efficacy in chemotherapy regimens. …

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