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TIER trial

Dr Christopher Fox wants to trial a new treatment combination for people with a rare type of blood cancer called primary central nervous system lymphoma, a disease which currently has limited treatment options.

The context

Primary central nervous system lymphoma (PCNSL) is a rare type of aggressive non-Hodgkin lymphoma that only affects the central nervous system (CNS), which includes the brain, eyes and spinal cord. People with PCNSL are usually treated with chemotherapy but sometimes the lymphoma does not respond to chemotherapy and on occasions it can return after treatment. If this happens, there are few treatment options, so we need to find new ways to treat this group of people.

The project

Researchers want to try a new combination of cancer drugs: thiotepa, ifosfamide, etoposide and rituximab. Thiotepa, ifofamide and etoposide are chemotherapies. Thiotepa and ifosfamide work by interfering with the cancer cell’s DNA, preventing the cells from growing and dividing. Etoposide works by blocking an enzyme which is necessary for cancer cells to divide. Together, it’s hoped these drugs will destroy cancer cells. Rituximab is a type of therapy called a monoclonal antibody. It works by targeting a protein called CD20, which is found on the surface of blood cells. The antibody attaches to these cells, which triggers a response and causes the immune system to come attack and destroy these cells. Rituximab causes both healthy and cancerous white blood cells to be destroyed, but the body can replenish the healthy white blood cells once the treatment is over.

The aims

  • Discover the best dose of thiotepa to give to patients
  • See how well the combination of thiotepa, ifosfamide, etoposide and rituximab works for people with PCNSL