What are my options for treating DLBCL?

What are my options for treating DLBCL? The standard treatment option for DLBCL is called R-CHOP, which is a targeted drug, Ritoxamab, which is an antibody that attacks cancer cells specifically, combined with CHOP, which is a classical cocktail of chemotherapy. It combines steroids as well as what we call cytotoxic chemotherapy, so chemicals that kill cancer cells. R-CHOP has been around since 2006 with Ritoxamab included, because in around 2006 they found out that including the targeted therapy, Ritoxamab significantly improves DLBCL outcomes. But CHOP part has been around since the 90s. And the reason why we have this treatment that's been around for so long is because it's extremely good and it cures about 60% of patients up front. Of course, there is a multitude of other therapies, and we have therapies approved almost every six months for diffuse large B-cell lymphoma, and they include antibodies such as Taffa-citamab. It attacks specifically lymphoma cells and an epitopes of molecule in lymphoma cells called CD19. There is another amazing drug called Polotuzumab, and it's an antibody loaded with chemotherapy molecules. So it targets chemotherapy directly to lymphoma cells so that there is toxicity to lymphoma cells, but not the rest of the body. And there is this amazing new bioweapon called CAR T-cells, chimeric antigen receptor T-cells. So basically our own immune system cells, T-cells, that are genetically modified in the lab to attack specifically lymphoma cells and do that very effectively. The traditional approach to treating this disease has been with systemic chemotherapy. So one other question that comes up is, I was diagnosed with a lump in my neck or I have a couple of lumps in different parts of the body. Why can't a surgeon just open me up and cut everything out? So again, that's again the distinction that lymphoma is a blood cancer and not like a solid tumor like breast cancer or pancreatic cancer where surgery is still an important part or component of treatment. For treating lymphomas, because again the blood goes everywhere, so the treatment needs to be systemic. And chemotherapy is still an important component of this treatment. Then in the late 90s, an important addition to chemotherapy came in the form of immunotherapy with a drug called Rituximab. So the combination of Rituximab with chemotherapy is currently still considered one of the standards of care for upfront treatment. And chemotherapy comes in different forms. And one of the common things if you just type in diffuse large B-cell lymphoma on the web, the first thing that comes up is something called CHOP. People all hear about this thing called R-CHOP. So R-CHOP stands for, we in oncology like to make acronyms, so each letter stands for a different drug. R stands for the Rituximab or the immunotherapy I was talking about. CHOP, C, H, and O stand for chemotherapy. And P stands for a drug called prednisone, which is a steroid. So R-CHOP is one of the still accepted standards of care to treat diffuse large B-cell lymphoma upfront. And again, over the past 10 to 20 years, people have tried to improve on R-CHOP by adding X, Y, and Z to R-CHOP. An important addition is adding one more immunotherapy drug with a drug called Pola in short. Or Polituzumab to the R-CHOP backbone and substituting the O drug for the Pola is now another option for people with slightly more aggressive versions of DLBCL. One of the biggest, I would say, blockbusters that we have now for the suicide is the administration of immunotherapies, neuroimmunotherapies. They can be in the form of like antibodies or CARP-P cells. We and others are trying to improve the way that these treatments are working by not only understanding how to attack the lymphoma cell itself, but also the normal cells that surround and sometimes maintain the lymphoma cell. So by doing so, that is actually one of my researches, trying to cut the way that the supporting cells communicate with the lymphoma cells. So by doing so, we improve how other treatments work including immunotherapies. They have multiple options. The most commonly used regimen is still something called R-CHOP. When they Google their disease, that's probably the first treatment they're going to see. There are now other FDA approved treatments, something called Pola R-CHOP. Or if they have certain alterations in the genetic makeup of their disease, they might benefit from something called Dose-Adjusted EPOC, or if they have central nervous system involvement, their frontline treatment needs to incorporate certain medications that goes into the brain. So they're very different approaches and the treatment needs to be individualized. A majority of these treatments that are currently approved are chemotherapy based. Pretty much all regimens with DLBCL involve targeted therapies as well. The most commonly used targeted therapy in DLBCL is anti-CD to any monoclonal antibodies. These are basically added to the chemotherapy backbone and given to the patients. Again, with DLBCL, the chances of lymphoma coming back are about 40% or so. Of course, it's very individual depending on some initial risk factors such as age, such as stage, such as subtype. But we all always calculate the relapse risk individually for each patient. But if it does come back, we have a lot of tools. As I have mentioned, there are a lot of novel therapies that are not very damaging for the patient body in general, but attack lymphoma cells specifically. We have transplants such as autologous transplants, or the transplant for our own stem cells to consolidate the remission and make sure lymphoma doesn't come back. And then again, we have those CAR T cells, chimeric antigen receptor T cells, that work in lymphomas where nothing else is working. So basically, they're FDA approved for what's called refractory lymphomas. So no chemotherapy or targeted agents are working on this disease and the CAR T cells can attack this disease and lead to substantial cure rates in these patients. There are multiple clinical trials looking into chemotherapy, three regimens, basically a combination of targeted therapies. Or there are clinical trials exploring addition of other forms of immunotherapy to chemotherapy backbone. I anticipate that the landscape of the DLV cell treatment is going to continue to change over the next few years.