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What You Need to Know: Hematologic Malignancies

Panelists: John Leonard, MD, New York-Presbyterian/Weill Cornell Center for Lymphoma and Myeloma; C. Ola Landgren, MD, Memorial Sloan Kettering Cancer Center; Alexander Perl, MD, Perelman School of Medicine, University of Pennsylvania; Anas Younes, MD, Memorial Sloan Kettering Cancer Center
Published: Thursday, Dec 07, 2017



Transcript: 

John Leonard, MD: Just 1 minute each, things that you think people need to know about. I’ll start with you again, Anas, and we’ll just go in the same order as we covered the topics.

Anas Younes, MD: I think for lymphoma, the biggest things for us right now are the CAR-T cells. I think the field is moving so quickly, but there’s a lot of excitement. We need longer term follow-up to determine how this will fit in the clinical practice of the average oncologist. And I think in ADCs, beyond Hodgkin’s lymphoma, we haven’t talked much about them in non-Hodgkin’s lymphoma, it’s gaining traction. There are 2 antibody drug conjugates for B-cell lymphoma. The polatuzumab looks very promising, and also another one targeting, actually a couple of them targeting, CD19 with different payloads that also look promising, so we need to keep an eye on those.

John Leonard, MD: Great. Sasha?

Alexander Perl, MD: I think 2017 was a fantastic year for drug development in acute leukemias, whether it was the 4 new drugs in AML, which is unprecedented or the development of CAR-T cells in ALL. It has just been a really exciting time. So, obviously, people are paying a lot of attention to CAR-T cells for ALL. I think it is still a process that needs to be done in centers that are quite experienced with this because of the exceptional toxicities that can be seen, and that’s really the way that these are being developed. Immunotherapy is very interesting for AML, but I think it’s still very early. And I think what we are finding is that there are actionable mutations and really good drugs out there now, and we’re likely to see more approvals in the next year or two. So, in the FLT3 world, in the BCL2 world, in the IDH world, there are likely going to be new drugs approved relatively soon.

John Leonard, MD: Ola?

C. Ola Landgren, MD: I think similar to the other disease areas, CAR T cells are going to be interesting in myeloma to see where we’re landing, which of these different CAR T cells are actually going to be the winners, who will they improve? We will need to see larger numbers, longer follow-up, and in different ways, how to use them. We didn’t talk so much about the various monoclonal antibodies that were in development. I think that is very interesting also in myeloma. We have the antibody conjugates. There are several BiTEs in development also. That will also continue to be very interesting, and that will, in some way, maybe compete with CAR T cells or it will just be in addition to that because you could think of those drugs going in combination with all the other already established drugs. So, that will be super interesting to see where we’re going to land. And I also think that with more sophisticated MRD tools being developed, becoming available, that will also clean up the field. We will learn better how to use the drugs. Could we even think of these tests to guide therapy and do things like that? That’s going to be very important.

John Leonard, MD: And I’ll just highlight the area of circulating tumor DNA and minimal residual disease. But in particular, there’s almost, I think in lymphoma, a whole session at ASH on variations of circulating tumor DNA, and we now can do methylation profiling on blood samples. This is going to potentially change a lot about, can we get things from the blood? This parallels what’s happening in solid tumors, and if we can turn that into actionable information—as we talked about earlier—that we can actually use to treat a patient better, I think it could be very exciting and useful for patients over time, but still a lot of work to do.

I want to thank all of you. This has been a really great discussion. I’ve learned a lot. I hope that you found this information to be very valuable to your practice, that you’re looking forward to delving into more details of these abstracts, a lot of exciting things happening. We hope that this program has been helpful to you. We welcome your feedback on this and what we talked about today, and we’d be very happy if you send us any suggestions you have regarding this programming to improve future projects like this to onclivenn@onclive.com. Thank you all very much for joining us today and watching the OncLive® News Network®.

Transcript Edited for Clarity 
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Transcript: 

John Leonard, MD: Just 1 minute each, things that you think people need to know about. I’ll start with you again, Anas, and we’ll just go in the same order as we covered the topics.

Anas Younes, MD: I think for lymphoma, the biggest things for us right now are the CAR-T cells. I think the field is moving so quickly, but there’s a lot of excitement. We need longer term follow-up to determine how this will fit in the clinical practice of the average oncologist. And I think in ADCs, beyond Hodgkin’s lymphoma, we haven’t talked much about them in non-Hodgkin’s lymphoma, it’s gaining traction. There are 2 antibody drug conjugates for B-cell lymphoma. The polatuzumab looks very promising, and also another one targeting, actually a couple of them targeting, CD19 with different payloads that also look promising, so we need to keep an eye on those.

John Leonard, MD: Great. Sasha?

Alexander Perl, MD: I think 2017 was a fantastic year for drug development in acute leukemias, whether it was the 4 new drugs in AML, which is unprecedented or the development of CAR-T cells in ALL. It has just been a really exciting time. So, obviously, people are paying a lot of attention to CAR-T cells for ALL. I think it is still a process that needs to be done in centers that are quite experienced with this because of the exceptional toxicities that can be seen, and that’s really the way that these are being developed. Immunotherapy is very interesting for AML, but I think it’s still very early. And I think what we are finding is that there are actionable mutations and really good drugs out there now, and we’re likely to see more approvals in the next year or two. So, in the FLT3 world, in the BCL2 world, in the IDH world, there are likely going to be new drugs approved relatively soon.

John Leonard, MD: Ola?

C. Ola Landgren, MD: I think similar to the other disease areas, CAR T cells are going to be interesting in myeloma to see where we’re landing, which of these different CAR T cells are actually going to be the winners, who will they improve? We will need to see larger numbers, longer follow-up, and in different ways, how to use them. We didn’t talk so much about the various monoclonal antibodies that were in development. I think that is very interesting also in myeloma. We have the antibody conjugates. There are several BiTEs in development also. That will also continue to be very interesting, and that will, in some way, maybe compete with CAR T cells or it will just be in addition to that because you could think of those drugs going in combination with all the other already established drugs. So, that will be super interesting to see where we’re going to land. And I also think that with more sophisticated MRD tools being developed, becoming available, that will also clean up the field. We will learn better how to use the drugs. Could we even think of these tests to guide therapy and do things like that? That’s going to be very important.

John Leonard, MD: And I’ll just highlight the area of circulating tumor DNA and minimal residual disease. But in particular, there’s almost, I think in lymphoma, a whole session at ASH on variations of circulating tumor DNA, and we now can do methylation profiling on blood samples. This is going to potentially change a lot about, can we get things from the blood? This parallels what’s happening in solid tumors, and if we can turn that into actionable information—as we talked about earlier—that we can actually use to treat a patient better, I think it could be very exciting and useful for patients over time, but still a lot of work to do.

I want to thank all of you. This has been a really great discussion. I’ve learned a lot. I hope that you found this information to be very valuable to your practice, that you’re looking forward to delving into more details of these abstracts, a lot of exciting things happening. We hope that this program has been helpful to you. We welcome your feedback on this and what we talked about today, and we’d be very happy if you send us any suggestions you have regarding this programming to improve future projects like this to onclivenn@onclive.com. Thank you all very much for joining us today and watching the OncLive® News Network®.

Transcript Edited for Clarity 
View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: 1st Annual European Congress on Hematology™: Focus on Lymphoid MalignanciesJan 30, 20182.0
Cancer Summaries and Commentaries™: Update from San Diego - Advances in the Treatment of Multiple MyelomaJan 31, 20181.5
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