About targeted cancer drugs

Targeted cancer drugs work by ‘targeting’ the differences that help a cancer cell grow and survive. Some seek out and destroy cancer cells. Others help the body's immune system to attack the cancer. So some of these drugs are also called immunotherapies.

You might also hear some targeted drugs called biological therapies.

When you have these drugs

You might have a targeted drug as a standard treatment for some types of NHL. Or you might have one as part of a clinical trial.

You have targeted therapy in combination with chemotherapy for some types of NHL. Some people have it on its own as part of their maintenance therapy. Maintenance treatment aims to keep the lymphoma in remission for as long as possible. Remission means there is no sign of the lymphoma.

Below are some examples of targeted cancer drugs for NHL.

Monoclonal antibodies (MABs) for NHL

Monoclonal antibodies (MABs) are the most common type of targeted drug used for NHL. They are proteins made in the laboratory from a single copy of a humanised antibody.

MABs work by recognising and finding specific proteins on, or in cancer cells.

Rituximab (Mabthera)

Rituximab is one of the main MABs used to treat NHL.

Rituximab targets a protein called CD20 on the surface of the lymphoma cells. The antibody sticks to all the CD20 proteins it finds. This makes it easier for the cells of the immune system to pick out the marked cells and kill them. Because of the way it works, rituximab is also called a targeted immunotherapy.

Rituximab is used to treat some types of NHL including:

• follicular lymphoma
• MALT lymphoma
• mantle cell lymphoma
• diffuse large B cell lymphoma

You might have it as a treatment on its own. Or in combination with chemotherapy (chemoimmunotherapy).

Obinutuzumab (Gazyvar)

Another type of MAB that is a treatment for NHL is obinutuzumab. It works in a similar way to rituximab.

You might have obinutuzumab for your follicular lymphoma in one of the following situations:

• as your first treatment for advanced disease
• if your rituximab treatment hasn't worked
• if your lymphoma has got worse within 6 months of rituximab treatment

You have it with the chemotherapy drug bendamustine for up to 6 months. Then you might have obinutuzumab alone as maintenance treatment. 

You might have obinutuzumab with the chemotherapy drugs cyclophosphamide, vincristine and the steroid prednisolone (CVP). 

Polatuzumab vedotin (Polivy)

You might have a MAB called polatuzumab vedotin (Polivy) with rituximab and bendamustine if you have diffuse large B-cell lymphoma that has come back after treatment (relapsed), and you are unable to have a stem cell transplant. 

Some people who haven't had treatment for diffuse large B-cell lymphoma before may have polatuzumab vedotin with R-CHP. This is a combination of:

• rituximab
• cyclophosphamide
• doxorubicin
• prednisolone

Side effects of MABS

The side effects you have depend on:

• which drug you have
• whether you have it alone or with other drugs
• your general health

The possible side effects of MABs include:

• skin changes such as red and sore skin or an itchy rash
• diarrhoea
• tiredness
• flu-like symptoms such as chills, fever, dizziness
• feeling or being sick

A common side effect of some MABs is an allergic reaction to the drug. This reaction is most likely to happen during treatment and when you first have the treatment. You have some drugs before treatment to try to prevent a reaction if this is possible with your drug.

Your medical team will talk through possible side effects. They will explain when you should contact them.

For more information about the side effects of your treatment go to the individual drug pages.

Other targeted drugs

Idelalisib (Zydelig)

Idelalisib is a cancer growth blocker. It works by blocking particular proteins inside cancer cells that encourage the cancer to grow. Idelalisib blocks a protein called PI3K and is called a PI3K inhibitor.

You might have idelalisib for follicular lymphoma if you have had at least 2 other types of treatment and they are no longer working.

Bortezomib (Velcade)

Some people with mantle cell lymphoma might have treatment with bortezomib. 

Bortezomib is a type of targeted cancer drug called a proteasome inhibitor. Proteasomes are in cells. They help to break down proteins that the cell doesn't need. Bortezomib blocks the proteasomes so the proteins build up inside the cell. The cell then dies.

You might have bortezomib as your first treatment for mantle cell lymphoma if you are not able to have a stem cell transplant. You might have it as a treatment on its own, or in combination with chemotherapy.

Ibrutinib (IMBRUVICA)

Ibrutinib is a cancer growth blocker called a tyrosine kinase inhibitor (TKI). It blocks chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells. So blocking them stops the cell growing and dividing.

Ibrutinib is used to treat some people with certain types of NHL including:

• Waldenstrom’s macroglobulinaemia
• mantle cell lymphoma

Having targeted cancer drug treatment

You have your targeted treatment in one of the following ways:

• as tablets or capsules
• as an injection under your skin
• through a tube into your bloodstream

How you have it depends on the type of drug you have.

Tablets or capsules

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

Into the bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Injection under your skin

You usually have injections under the skin (subcutaneous injection) into the stomach, thigh or top of your arm.

You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.

When you go home

Treatment with targeted drugs can be difficult to cope with for some people. Your nurse will give you a number to call (advice line) if you have any problems at home.

Other targeted cancer drugs

A number of other targeted drugs are being developed and tested for treating NHL. You might have them in combination with chemotherapy.

Drugs that are being looked at include:

• acalabrutinb
• venetoclax
• pembrolizumab