Lymphoma Highlights from the 2017 American Society of Hematology Annual Meeting, with Michael E. Williams, MD, ScM

January 9, 2018
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In today’s podcast, Cancer.Net Associate Editor, Dr. Michael Williams will discuss some of the new research that was presented at the 2017 American Society of Hematology Annual Meeting, held December ninth through twelfth in Atlanta, Georgia.

Transcript: 

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In today’s podcast, Cancer.Net Associate Editor, Dr. Michael Williams will discuss some of the new research that was presented at the 2017 American Society of Hematology Annual Meeting, held December ninth through twelfth in Atlanta, Georgia. Dr. Williams is the Chief of the Hematology/Oncology Division and Director of the Hematologic Malignancies Program at the UVA Cancer Center, and Byrd S. Leavell Professor of Medicine and Professor of Pathology at the University of Virginia School of Medicine.

Dr. Williams: Hi. This is Dr. Michael Williams. I'm a professor at the University of Virginia Hospital in Charlottesville, and I'm going to discuss some of the important research highlights in lymphoma that were presented at the recent American Society of Hematology Annual Meeting, which was held in Atlanta in early December 2017. Well, there continue to be important and impressive advances in treatment options and improved outcomes for patients with many of the types of lymphoma that we see most commonly. And so, I'm going to go through just a few of these with you today.

The first relates to Hodgkin lymphoma, which often affects younger adults or adolescents. And this was a very important, large scale study conducted internationally. And it tested the current standard therapy of a treatment regimen called ABVD, against a newer regimen that is very similar, but it removes a drug called bleomycin and substitutes brentuximab vedotin, which is an agent that's approved for Hodgkin's lymphoma in the relapse setting.

So the question was, if you add this targeted drug to a backbone of standard therapy, does it improve outcomes for patients with advanced Hodgkin lymphoma who have not had any prior treatment? The results of the study showed that, with relatively early follow-up, thus far, that patients who received the newer treatment approach had a better disease control by about 5% over the standard treatment approach with ABVD. So that means that at 2 years, there were more patients who were maintaining their remission with the newer treatment as compared with the current standard of ABVD.

So a very promising finding, and it's important for several reasons for patients with advanced Hodgkin. First of all, the newer agent did not have nearly the risk of pulmonary toxicity that is seen when bleomycin is incorporated into the treatment. There was different toxicity in that patients with brentuximab therapy had more difficulties with low blood counts and infections, but this could be ameliorated in part by giving white blood cell growth factors that help address the low counts.

So it's not a new standard of care for all patients at this point. I think longer follow-up is going to be needed for any later side effects or toxicities. There needs to be some consideration of the added cost of the new agent as compared with the older regimen, which may be significant for some patients. But it does present a new approach for treatment and one that should be discussed for anyone undergoing treatment for advanced stage Hodgkin lymphoma.

The second lymphoma type that I want to mention is mantle cell lymphoma. This is a disease that has a very wide clinical spectrum. Some patients have a very slow growing disease, while others have a much more rapid progression and need intervention to control the disease well. An important advance in this disease a few years ago was the development of a drug called ibrutinib, which is also approved in chronic lymphocytic leukemia and other types of non-Hodgkin lymphoma aside from mantle cell, such as Waldenstrom macroglobulinemia and marginal zone lymphoma.

So this is an oral drug that's generally fairly well tolerated. It can have side effects such as diarrhea in a small percentage of patients, bleeding difficulties or easy bruising, or atrial fibrillation. But an update with long-term follow-up of this treatment with just using ibrutinib by itself for relapsed mantle cell lymphoma shows that some patients are continuing to have good control of their disease 3 to even 5 years from the initiation of treatment. Importantly, they found that in patients who got ibrutinib earlier in the course of disease, for example, at the time that they initially relapsed rather than after they had been treated with 2 or 3 different lines of therapy, that those responses were much more durable than people who were very heavily pre-treated. So it makes a case for earlier use of this targeted drug after progression following initial treatment.

There were also 2 new drugs that also target the Bruton tyrosine kinase, or BTK. One called a acalabrutinib, which also showed very high activity and evidence that some of the side effects that I mentioned for ibrutinib, such as atrial fibrillation and bleeding and bruising risk, seem to be much less in frequency. So that provides another option that's available for relapse mantle cell. And there are other BTK inhibitors that are also in development. So just an example of the many targeted therapeutics for chronic lymphocytic leukemia and other B cell malignancies that are really changing the landscape of how we approach the treatment of these diseases and allows us in many cases to minimize or avoid traditional chemotherapy.

The final advance in research that I want to comment upon is something that's been in the news a lot over the past couple of years, and that is CAR T-cell therapy for relapsed lymphoma. So CAR T stands for chimeric antigen receptor T cell. And it's a complex therapy, but in a nutshell, a patient's T lymphocytes, which are part of their immune system, are removed from the patient and then reprogrammed to target residual lymphoma cells in the patient. So once these T cells are armed to attack lymphoma cells, they're expanded in the laboratory and then reinfused into the patient.

There were two studies. One presented by Dr. Steven Schuster at the University of Pennsylvania, and by Dr. Sattva Neelapu at MD Anderson Hospital. Both used different CAR T-cell products that have the same principle. These were multicenter studies that showed the feasibility of using this therapy for patients with relapsed large cell lymphoma. But there's also encouraging news in many other types of lymphoma that we may also be able to apply these powerful immunotherapies for patients who currently would not have other good treatment options. And 1 of these has now been approved by the Food and Drug Administration as a therapy for relapsed lymphoma.

So it's an important consideration in the relapse setting, especially for patients whose disease has been very resistant to traditional chemotherapy regimens. So something that you should discuss with your oncologist if that is your situation. So overall, a very exciting American Society of Hematology meeting, lots of advances, and a very encouraging time for patients with lymphomas of all sorts for continued improvement in outcomes and remissions for these patients. Thanks very much.

ASCO: Thank you, Dr. Williams. To find more information about these topics, visit www.cancer.net.  And for more expert interviews and stories from people living with cancer, visit the Cancer.Net Blog at www.cancer.net/blog.

Cancer.Net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net Podcast.

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