Press brief by Tony Green, MD, PhD of the Cambridge Institute for Medical Research, Cambridge, UK, at the 2016 Annual Meeting of the European Association of Hematology (EHA), held in Copenhagen, Denmark.
Author: Editor
Giuseppe Saglio, MD of the University of Turin, Turin, Italy provides an overview of the results of the Phase III trial of DASISION in patients with chronic myeloid leukemia (CML) and the future of CML treatment (NCT00481247). In the DASISION trial, patients were randomized to receive either dasatinib or imatinib therapy. The findings were in favor of dasatinib therapy, which resulted in deeper and faster achievement of molecular response and further, it was well tolerated. There was a problem with the occurrence in some cases of pleural effusions. When this occurred the treatment was restarted or dosage was reduced. Prof…
In this Ask the Expert segment, Terry is concerned about his mothers treatment and side effects. He wants to know if a reduction of the dose of Revlimid and dexamethasone will make the treatment less effective. MPN expert Dr. Jatin Shah, a myeloma expert from MD Anderson Cancer Center, responds with a discussion of the balance between managing side effects and dosage as well as various causes of GI upsets. Get email alerts | http://www.patientpower.info/alerts Subscribe on YouTube | http://www.youtube.com/patientpower Like on Facebook | http://www.fb.com/patientpower.info Follow on Twitter | http://www.twitter.com/patientpower Follow on Google+ | http://www.google.com/+patientpowerinfo
Evan Yu, MD of Seattle Cancer Care notes that some patients saw dramatic improvement in IMvigor210 trial
From our MPN Ask the Expert series, Patient Power viewer, Jane, asks a question about using iron supplements for MPN patients who are anemic due to iron deficiency. MPN expert Dr. John Mascarenhas of Mount Sinai School of Medicine responds with a two-part answer: one for polycythemia vera (PV) patients and another for myelofibrosis (MF) patients. Get email alerts | http://www.patientpower.info/alerts Subscribe on YouTube | http://www.youtube.com/patientpower Like on Facebook | http://www.fb.com/patientpower.info Follow on Twitter | http://www.twitter.com/patientpower Follow on Google+ | http://www.google.com/+patientpowerinfo
In this Ask the Expert segment, Terry is concerned about his mothers treatment and side effects. He wants to know if a reduction of the dose of Revlimid and dexamethasone will make the treatment less effective. MPN expert Dr. Jatin Shah, a myeloma expert from MD Anderson Cancer Center, responds with a discussion of the balance between managing side effects and dosage as well as various causes of GI upsets. Get email alerts | http://www.patientpower.info/alerts Subscribe on YouTube | http://www.youtube.com/patientpower Like on Facebook | http://www.fb.com/patientpower.info Follow on Twitter | http://www.twitter.com/patientpower Follow on Google+ | http://www.google.com/+patientpowerinfo
POPLAR trial success leads to larger OAK study
Autoimmune can be delayed in immunotherapy
Alexander Spira, MD of the Cleveland Clinic discusses the results of Phase II POPLAR trial evaluating Atezolizumab in advanced NSCLC
Nathan Pennell, MD of Cleveland Clinic discusses his experience with Nivolumab and Pembrolizumab in the second line therapy of your NSCLC patients
Omid Hamid, MD of the Angeles Clinic discusses the phase III NEMO trial and the novel MEK inhibitor Binimetinib
Petros Grivas, MD of Cleveland Clinic discusses the efficacy of Atezolizumab within cohort 2 of IMvigor210
Arjun V. Balar, MD of NYU Langone Medical Center discusses the percentage of patient with urothelial cancer that are cisplatin ineligible
Dr. Fadi Braiteh, MD of Comprehensive Cancer Centers of Nevada describers the differences in Squamous Cell Carcinomas versus the Non-Squamous Cancers when using Atezolizumab
Dr. Ramaswamy Govindan, MD of the Washington University Medical School gives an update on BRAF in NSCLC from ASCO 2016
Dr. Heather Wakelee, MD of the Stanford School of Medicine outlines the best way to test newly diagnosed NSCLC in the community setting
Jeffrey Jones, MD, MPH from the Ohio State University, Columbus, OH discussing the characteristics and mode of action of Ibrutinib. Ibrutinib targets the B-cell receptor signalling pathway, specifically inhibiting the Brutons tyrosine kinase (BTK). BTK is mutated in patients with X-linked agammaglobulinemia and consequently born without mature B-cells. From this knowledge it was hypothesised that pharmacological inhibition of BTK could eradicate abnormally functioning B-cells, and so ibrutinib was developed. Ibrutinib is orally bioavailable and only needs to be taken once a day, with a lasting effect of 24 hours. According to Dr Jones most patients see improvement in symptoms soon…
Jeffrey Jones, MD, MPH from the Ohio State University, Columbus, OH discusses the current thought on treating relapsed and refractory chronic lymphocytic leukemia (CLL). This is an area where one can see a tremendous revolution in CLL treatment. Treatment has moved from once being mostly chemotherapy to more specifically targeting the abnormal biology of CLL. In order to do this there needs to be a fundamental understand of CLL, specifically what drives CLL growth and survival. Recorded at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark
Mohamad Mohty, MD, PhD from Saint-Antoine Hospital, Paris, France discussing treatment options for relapsed and refractory myeloma at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark. Due it is current high prevalence in the research field the physician’s role is becoming harder as there is a wider choice of therapies. When choosing these therapies practitioners need to consider age, comorbidities, prior history, bone-marrow reserves, organ dysfunction, as well as disease features and manifestations. When putting these components together management and sequence of treatments becomes complex, however Prof Mohty is confident that on a case by case basis…
Giuseppe Saglio, MD from University of Turin, Turin, Italy discusses the influence of TKI therapy on the treatment of chronic myeloid leukemia (CML). Over the past few years it has been shown that patients can achieve a status called operational cure, where it is possible for them to stop therapy- however the number of patients holding this status is low. Dr Saglio holds hope that in the future this number will rise and mentions the potential of using a stronger TK inhibitor to increase the number of patients holding an operational cure. Recorded at the European Hematology Association (EHA) 2016…
Antonio Palumbo, MD from the University of Turin, Turin, Italy talks about when daratumumab will be available in combination with bortezomib and dexamethasone or lenalidomide and dexamethasone. Daratumumab is approved as a single agent by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA). According to Dr Palumbo, the submission for the three agent submission will be started and it should be available within 12-18 months. Recorded at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark.
Haifa Kathrin Al-Ali, MD from University of Leipzig, Leipzig, Germany discusses research into JAK inhibitors specifically Ruxolitinib, Pacritinib, and Momelotinib. Ruxolitinb demonstrated positive results in the COMFORT-II trials (NCT00934544), reducing splenomegaly and symptom improvement. Similar results were also seen with pacritinib. There is still no to data on momelotinib from the most recent clinical Phase III trial. Recorded at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark.
Antonio Palumbo, MD from the University of Turin, Turin, Italy discusses the place of daratumumab in the current treatment landscape of multiple myeloma (MM). According to Dr Palumbo, daratumumab will change the treatment paradigm and will be combined to bortezomib and dexamethasone or lenalidomide and dexamethasone. Recorded at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark.
Niels van de Donk, MD, PhD from the University Medical Center, Amsterdam, Netherlands discusses three trials of daratumumab in multiple myeloma (MM). First, Dr van de Donk outlines the results of the Phase III POLLUX trial of daratumumab combined with lenalidomide and dexamethasone (DRd) vs lenalidomide and dexamethasone (Rd) (NCT02076009). The trial was perfomed in the relapsed/refractory setting. There was an increase in response rate, complete response rate and further progression-free survival (PFS) was improved in the DRd vs the Rd arm. According to Dr van de Donk, this is the best triplet combination tested so far. He also discusses…
Haifa Kathrin Al-Ali, MD from University of Leipzig, Leipzig, Germany discusses janus kinase (JAK) inhibitors at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark. There is only one drug approved, at present, for the treatment of polycythemia vera (PV) and myelofibrosis (MF) – ruxolitinib a JAK 1/JAK 2 inhibitor. Prof Kathrin also discusses pacritinib a JAK 1 inhibitor and momelotinib a JAK 1 and JAK 2 inhibitor. Fedratinib is a JAK 2 inhibitor however developed has been halted due to safety concerns as some patients have developed Wernicke’s encephalopathy.
Josep-Maria Ribera, MD, PhD from Germans Trias i Pujol University Hospital, Barcelona, Spain outlines the importance of blinatumomab and inotuzumab ozogamicin in treating acute lymphoblastic leukemia (ALL). Both blinatumomab and inotuzumab ozogamicin are very effective in a relapsed refractory settings. Dr Ribera believes that these agents are best used earlier in the disease, specifically in first remission, when there is still minimal residual disease (MRD) to be eliminated. Recorded at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark.
Shaji Kumar, MD from the Mayo Clinic, Rochester, MN discusses the current research on immunotherapy in multiple myeloma (MM). The biggest advance so far is daratumumab according to Dr Kumar. Daratumumab is a monoclonal antibody targeting CD38 and its has been to shown to have high efficacy as single agent and in combination with lenalidomide and bortezomib. Elotuzumab, which targets SLAMF7, has also been shown to be active in combination with bortezomib and pomalidomide. Dr Kumar further discusses CAR T-cell therapy, which is in early clinical development and has shown efficacy in leukemia with some reports that it might also…
Josep-Maria Ribera, MD, PhD from Germans Trias i Pujol University Hospital, Barcelona, Spain outlines his talk on minimal residual disease (MRD) and how MRD is assessed by different European groups treating adults with acute lymphoblastic leukemia (ALL). The talk confirmed the crucial role of MRD and highlighted the importance of standardization of MRD methods. Recorded at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark.
Antonio Palumbo, MD from the University of Turin, Turin, Italy gives an overview of the results of the Phase III CASTOR trial of daratumumab with bortezomib and dexamethasone (NCT02136134). This combination reduces the risk of progression by 60% compared to the current standard of care according to Dr Palumbo. Daratumumab is a novel monoclonal antibody, which targets a specific tumor antigen for myeloma plasma cells (CD38), which leads to an increase of the response rate with a doubling of the rate of complete remission (CR) and very good partial response (VGPR). Further, five times as many patients achieve minimal residual…
Josep-Maria Ribera, MD, PhD from Germans Trias i Pujol University Hospital, Barcelona, Spain outlines the clinical practice of acute lymphoblastic leukemia (ALL). Although treatments are individualised due to the number and complexity of the diseases, there are several principles which are followed worldwide. These include the notion that chemotherapy is provided first, that adults should be considered for transplant and the minimal residual disease (MRD) is of high importance. Recorded at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark.
Shaji Kumar, MD from the Mayo Clinic, Rochester, MN discusses venetoclax and the future of treatment of multiple myeloma (MM). Venetoclax is an inhibitor of BCL-2, which is generally highly expressed on multiple myeloma cells. According to Dr Kumar, pre-clinical studies show that venetoclax is active against myeloma cells and he further discusses the results of the Phase I trial of venetoclax as a single agent (NCT01794520) and the Phase I trial of venetoclax with bortezomib and dexamethasone (NCT01794507). Recorded at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark.
Simon Rule, MD from Derriford Hospital, Plymouth, UK discusses current mantle cell lymphoma (MCL) news, including the novel results from clinical trials using ibrutinib and front-line allogeneic transplant. Allogeneic transplant is often not the first-line of treatment due to its toxicity. Instead, treatment for younger patients involves chemotherapy then an autologous stem cell transplant, however patients often still relapse. Prof Rule discusses his clinical trial (NCT00720447) of 25 patients undergoing an allogeneic transplant with a transplant rate of mortality of 8% and progression-free survival 3 years rate of 70%. This suggests that there may be a potential application for patients…
Valeria Santini, MD from University of Florence, Florence, Italy outlines the mode of action of hypomethylating agents – azacitidine and decitabine – in the treatment of myelodysplastic syndromes (MDS). Hypomethylating agents were derived by cytidine analogues and originally synthesized to be similar to ara-C. However it was found that these agents acted through hypomethylating DNA. This is demonstrated when looking at patients DNA who have been given azacidine, it is possible to see a decrease in methylation after single-treatment. Recent research according to Dr Santini has shown that methylation occurs throughout the DNA and not just at the promoter. Therefore…
Michael Hallek, MD from the University of Cologne, Cologne, Germany discusses the debate around whether chronic lymphocytic leukemia (CLL) is curable. Prof Hallek argues that it is possible to cure CLL patients and points out that allogeneic stem cell transplants cure approximately 30-40% of patients. In terms of non-transplant therapies, there is evidence that long-term remission is achievable. Some patients who have received FCR (fludarabine, cyclophosphamide, rituximab) remain in remission after many years and can be categorized according to their IGHV mutation status, whereby IGHV-mutated patients have a good prognosis. Within the group of IGHV-mutated patients, patients with trisomy 12,…
Marek Trneny, MD, PhD from Charles University General Hospital, Prague, Czech Republic gives an overview of his talk on the unmet need for follicular lymphoma for a subgroup of patients resistant to immunotherapy. The outcome for these patients is poor with a median progression-free survival (PFS) between 6-10 months. Prof Trneny then discusses the results of the Phase III GADOLIN trial (NCT01059630), which looked at the whole spectrum of indolent lymphoma and in particular, patients resistant to ritxuimab. Patients were randomly assigned to the standard treatment of bendamustine or to an experimental arm of bendamustine plus obinutuzumab. According to Prof…
Katja Weisel, MD from University Hospital Tuebingen, Tuebingen, Germany discusses the slowly progressing myeloma and outlines how there are clear benefits to receiving lenalidomide and dexamethasone based backbone therapy for patients who have not had success with a proteasome inhibitor based first line of treatment. Patients receiving this treatment show a sustained and durable responses with a progression-free survival of 15-19 months. Dr Weisel continues to discuss the potential of combining lenalidomide and dexamethasone with a combination treatment. For instance carfilzomib, lenalidomide and dexamethasone combinations (NCT01080391). Recorded at the European Hematology Association (EHA) 2016 Annual Congress in Copenhagen, Denmark.
Valeria Santini, MD from University of Florence, Florence, Italy discusses the treatment of myelodysplastic syndromes (MDS). In Europe azacitidine is prescribed and is proving to be effective in prolonging survival, despite the fact that 50% of MDS patients do not respond to the drug. However these patients who show positive results with azacitidine lose this response after 6-26 months. Practitioners are now facing the issue of attending to patients who again need treatment, and consequently need to delay the progression to acute leukemia. New agents are being added to azacitidine in the hopes of increasing the duration of its efficacy,…
Simon Rule, MD from Derriford Hospital, Plymouth, UK outlines his presentation on his work with ibrutinib. Prof Rule discusses the outcome of a compilation of three trials involving the single-agent ibrutinib in 307 patients with relapsed/refractory mantle cell lymphoma. In these trials the response by baseline criteria, characteristics, progression free-survival (PFS) and complete survival were analyzed. It was known previously that ibrutinib has a 70% response rate, consequently instead these trials concentrated on progression-free survival and complete survival. Results showed that if ibrutinib is used at first relapse the results are hugely more significant in comparison to use in second…
Anna Schuh, MD, PhD, from the University of Oxford, discusses the importance of genomic analysis in chronic lymphocytic leukemia (CLL) in the clinic. According to Dr Schuh, the mutation analysis of TP53 in addition to a FISH analysis are important. She further discusses which other markers will become relevant in the future, which includes looking for subclonal TP53 mutations with next-generation sequencing (NGS) and whole genome sequencing. Recorded at the 2016 Annual Meeting of the British Society of Haematology (BSH) and International Society of Hematology (ISH), held in Glasgow, Scotland.
Charles Craddock, CBE, FRCP, FRCPath, DPhil, from Queen Elizabeth Hospital, Birmingham, UK provides an overview of his talk on allogeneic stem cell transplantation in eldery patients with acute myeloid leukemia (AML) held at the 2016 Annual Meeting of the British Society of Haematology (BSH) and International Society of Hematology (ISH) in Glasgow, Scotland. According to Prof Craddock, the focus was on the recent finding that reduced intensity transplants improve overall survival (OS) and the importance of patient co-morbidities. A substantial number of patients over the age 60 are at risk of relapse if they are treated with chemotherapy alone, according…
Gail Roboz, MD from Weill Medical College of Cornell University, New York, NY outlines the limited progress in acute myeloid leukemia (AML) research over the past decades. Standard care is still conventional chemotherapy or lower-intensity therapy generally with a lower dose cytarabine regimens. Practitioners can look at molecular genetics however its application has yet to have a positive influence on the treatment of older AML patients, according to Dr Roboz. Nonetheless, she says there is light on the horizon in the form of improvements to standard care as well as novel agents. Recorded at the 2016 Annual Meeting of the…
Charles Craddock, CBE, FRCP, FRCPath, DPhil, from Queen Elizabeth Hospital, Birmingham, UK discusses when a transplant is the most suitable option in elderly acute myeloid leukemia (AML) patients and what alternatives are open to these patients. Prof Craddock first explains how one can determine the quality of remission using minimal residual disease (MRD) testing, cytogenetic and molecular analysis. He then further explains how patients with a predicted risk of relapse higher than 40% will benefit from an allograft, as well as how co-morbidities scores should be considered when determining whether an allograft is suitable. Recorded at the 2016 Annual Meeting…
Charles Craddock, CBE, FRCP, FRCPath, DPhil, from Queen Elizabeth Hospital, Birmingham, UK explains how epigenetic drugs may have a capacity to modulate the immune system post-transplant in acute myeloid leukemia (AML). By demethylating the FOXP3 promoter it may be able to accelerate Treg reconstitution post-allograft and thereby potentially suppressing graft versus host disease. Prof Craddock also discusses the clinical trial RICAZA (ISRCTN36825171) in which 40 patients post-transplant azacidine was well-tolerated. Recorded at the 2016 Annual Meeting of the British Society of Haematology (BSH) and International Society of Hematology (ISH), held in Glasgow, Scotland
Anna Schuh, MD, PhD, from the University of Oxford, Oxford, UK, gives an overview of the CLL pilot run by Genomics England to test the robustness of the sample pathway for liquid cancers. Dr Schuh outlines the project, which has recruited over 300 chronic lymphocytic leukemia (CLL) patients from clinical trials. The aim is to identify new predictors of response to treatment, understanding the significance of non-coding regions and changes in the germline that might be important for drug metabolism. She further explains how more patients need to be recruited in order to draw conclusions from the data. Recorded at…
Dr. Alexander Spira, MD of Virginia Cancer Specialists goes over the risk and benefit to blocking PD-L2
Dr. Robert Dreicer, MD of the University of Virginia highlights small molecule inhibitor trials within urothelial cancer
Dr. Arjun V. Balar, MD of NYU Langone Medical Center discusses using deficient mismatch repair in PD-L1 therapy for urothelial cancer
Dr. Evan Yu, MD of Seattle Cancer Care Alliance notes that some patient populations may respond better to atezolizumab and other checkpoint inhibitors
Dr. Omid Hamid, MD of The Angeles Clinic discusses new predictive markers in immunotherapy for melanoma
Dr. Petros Grivas, MD of Cleveland Clinic outlines how the higher levels of PD-L1 expression correlates with higher response rates