Targeted Therapy Drugs for Non-Hodgkin Lymphoma

As researchers have learned more about the changes in lymphoma cells that help them grow, they have developed newer drugs to specifically target these changes. These targeted drugs work differently from standard chemotherapy (chemo) drugs. Sometimes they work when standard chemo drugs don’t, and they often have different (and less severe) side effects. 

Proteasome inhibitors

These drugs work by stopping enzyme complexes (proteasomes) in cells from breaking down proteins important for keeping cell division under control. They are more often used to treat multiple myeloma, but can be helpful in treating some types of non-Hodgkin lymphoma (NHL) as well.

Bortezomib (Velcade) is a proteasome inhibitor used to treat some lymphomas, usually after other treatments have been tried. Bortezomib is given as an infusion into a vein (IV) or an injection under the skin (subcutaneous, or sub-q), typically twice a week for 2 weeks, followed by a rest period. Side effects can be similar to those of standard chemo drugs, including low blood counts, nausea, loss of appetite, and nerve damage.

Histone deacetylase (HDAC) inhibitors

HDAC inhibitors are drugs that can affect what genes are active by interacting with proteins in chromosomes called histones

Romidepsin (Istodax) can be used to treat both peripheral and skin T-cell lymphomas. It is usually given after at least one other treatment has been tried. This drug is given as an IV infusion, usually once a week for 3 weeks in a row, followed by a week off. Side effects tend to be mild, but can include lowered blood cell counts and effects on heart rhythm.

Belinostat (Beleodaq) can be used to treat peripheral T-cell lymphomas, usually after at least one other treatment has been tried. It is given as an IV infusion, usually daily for 5 days in a row, repeated every 3 weeks. Common side effects include nausea, vomiting, tiredness, and low red blood cell counts (anemia).

Kinase inhibitors

These drugs block kinases, which are proteins in cells that normally relay signals (such as telling the cell to grow). Many different types of kinases exist, and there are two that are targeted by specific drugs used to treat NHL: Bruton's tyrosine kinase (BTK) and PI3K.

Bruton's tyrosine kinase (BTK) inhibitors

BTK is a protein that normally helps some lymphoma cells (B cells) to grow and survive.

Ibrutinib (Imbruvica) blocks the BTK protein. This drug can be used to treat several types of NHL, including mantle cell lymphoma, marginal zone lymphoma, and small lymphocytic lymphoma. It’s taken by mouth as capsules, once a day. Common side effects include diarrhea or constipation, nausea and vomiting, fatigue, swelling, decreased appetite, and low blood counts. This drug is currently approved for use after other treatments have been tried, and it’s now being studied for use earlier in treatment.

Calquence (acalabrutinib) is another drug that blocks BTK. It is used to treat mantle cell lymphoma, after at least one other treatment has been tried. This drug is taken by mouth as capsules, twice a day. Common side effects are headache, diarrhea, bruising, fatigue, muscle pain, and low blood counts. More serious side effects can include bleeding (hemorrhage), infections, and irregular heartbeat (atrial fibrillation).

PI3K inhibitors

PI3K is a protein that sends signals in cells and controls cell growth.

Idelalisib (Zydelig) blocks the PI3K protein. This drug has been shown to help treat follicular lymphoma and small lymphocytic lymphoma after other treatments have been tried. It’s taken as a pill twice a day. Common side effects include diarrhea, fever, fatigue, nausea, cough, pneumonia, belly pain, chills, rash and low blood counts. Less often, more serious side effects can also occur.

Copanlisib (Aliqopa) is another drug that blocks PI3K. It can be used to treat follicular lymphoma that comes back after other treatments have been tried. It’s given as an infusion into a vein, typically once a week for 3 weeks, followed by a week off. Common side effects include high blood sugar levels, nausea, diarrhea, feeling weak, high blood pressure, low levels of white blood cells (with increased risk of infection), and low levels of blood platelets (with increased risk of bruising or bleeding). Less common side effects include infections, inflammation in the lungs, and severe skin reactions.

For more general information about targeted therapy, see Targeted Therapy.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: May 31, 2016 Last Revised: September 14, 2017

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