By: Christopher Flowers, MD
Date: 09/22/2023
Dr. Christopher Flowers of MD Anderson Cancer Center expressed his gratitude to Sandeep for his excellent talk, acknowledging it as a perfect precursor to his own discussion on integrating tools into clinical practice and trials. Dr. Flowers shared his relevant disclosures, mainly involving his role as a consultant in lymphoma therapy development and his work in the Division of Cancer Medicine.
He proceeded to discuss Sandeep’s insights into classifying diffuse large B cell lymphoma into subsets based on gene expression profiling and immunohistochemistry. He highlighted that while this classification has been applied in studies, its value in clinical trials, as Sandeep pointed out, remains unclear.
Dr. Flowers emphasized the need to explore strategies for integrating biomarkers into clinical practice, drawing inspiration from the FDA’s biomarker acceleration pathway. He emphasized the importance of genomic data, traditional biomarkers like immunohistochemistry, and bioinformatic analytic pathways as potential biomarkers.
He also referred to a discussion at an AACR meeting in 2018 led by David Scott, which outlined challenges in integrating genomics into clinical practice. Dr. Flowers discussed the challenges related to core needle biopsies, mutation burden, and the need for standardized reporting standards and quality control.
Dr. Flowers delved into the concept of the “dark zone signature,” which identifies patients with poor outcomes beyond traditional classifications. He discussed the importance of microenvironment classification and its impact on prognosis.
In terms of future directions, Dr. Flowers highlighted the need for enhancing genomic subtyping, reducing uncertainty, linking subtypes to drug targets, and further exploring biological subsets. He emphasized the importance of rapid turnaround times for genomic testing and the potential for clinical trials to incorporate these data.
In conclusion, Dr. Christopher Flowers discussed the challenges and opportunities in integrating genomic data into the care of diffuse large B cell lymphoma patients, emphasizing the importance of tissue requirements, standardized reporting, and clinical trial design.