Andre Goy, MD

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses updates in CAR T-cell therapy that are being presented at the 2019 ASCO Annual Meeting.

Many of the studies presented at the 2019 ASCO Annual Meeting related to CAR T-cell therapy were trials in progress. However, one study that had data read out included a subset from the ZUMA-1 trial, which demonstrated promising efficacy and safety data in patients older than 65 years with axicabtagene ciloleucel (Yescarta). Moreover, in the TRANSCEND NHL 001 trial,  lisocabtagene maraleucel, another CAR T-cell product, also demonstrated benefit in patients with relapsed/refractory mantle cell lymphoma. 

In patients with relapsed/refractory central nervous system lymphoma, data also showed that CAR T-cell therapy is feasible and demonstrated preliminary activity. 

Videos

Dr. Goy on CAR T-Cell Therapy Updates in Non-Hodgkin Lymphoma

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses promising data with acalabrutinib (Calquence) in the treatment of patients with mantle cell lymphoma (MCL).

At the 2018 ASH Annual Meeting, Goy says there was an explosion of exciting data with small molecule inhibitors across the different hematologic malignancies. This holds true in MCL, where recent clinical trials have been attempting to shy away from the use of traditional cytotoxic chemotherapy in these patients. In the relapsed/refractory setting, BTK inhibitors are starting to rise to the forefront, and researchers presented long-term follow-up data with the second-generation inhibitor acalabrutinib at the meeting. This drug differs from the first-generation inhibitor ibrutinib (Imbruvica) in that there appears to be less off-target effects and less cardiotoxicity, if any.

At a follow-up of over 2 years, results showed a median duration of response with acalabrutinib of over 26 months with an overall response rate of over 80%. The complete response rate to the agent was approximately 60%, Goy says, which was really exciting. This efficacy and tolerability makes acalabrutinib a good candidate to combine with other small molecule drugs, he adds.

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses promising data with acalabrutinib in the treatment of patients with mantle cell lymphoma.

Dr. Goy on Promising Data With Acalabrutinib in MCL

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses the potential of immunotherapy in patients with mantle cell lymphoma (MCL).

Lenalidomide (Revlimid) and rituximab (Rituxan; R2) plus ibrutinib (Imbruvica) is a combination approach of immunotherapy and targeted therapy, explains Goy. At John Theurer Cancer Center, 71% of heavily pretreated patients with MCL experienced a complete response with the regimen. Additionally, a published study showed high response rates in patients with poor genetic risk factors.

Traditionally, when physicians think about immunotherapy, they think about chimeric antigen receptor T cells, says Goy. However, a lot remains unknown about the use of checkpoint inhibitors in MCL. Activity outside of primary mediastinal lymphoma and Hodgkin lymphoma has been relatively disappointing, explains Goy. However, there is a lot of potential with anti—CD47 antibodies that may enable physicians to give patients a biological induction, and subsequently consider immunotherapy in high-risk patients.

Dr. Goy on Immunotherapy in Mantle Cell Lymphoma

Andre Goy, MD, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses the combination of biological therapies in the treatment of patients with relapsed mantle cell lymphoma (MCL).

There are 5 approved agents in the relapsed setting with response rates of up to 80%, explains Goy. Acalabrutinib (Calquence) has demonstrated a 40% complete response (CR). Some of these agents have demonstrated a median duration of response of approximately 1.5 years. These agents are very attractive for patients who are chemoresistant, explains Goy.

Unless patients undergo immediate transplant, there is no chance of cure in the relapsed setting. However, when these biological therapies are combined, specifically rituximab (Rituxan) and lenalidomide (Revlimid) or venetoclax (Venclexta) and ibrutinib (Imbruvica), CR rates become more evident.

Goy states that the CR rate with ibrutinib and venetoclax was very impressive. Twelve of 19 patients went into a molecular CR with minimal residual disease negativity. These results give patients who have failed chemotherapy an option with a much better response and subsequent outcome.

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses the combination of biological therapies in the treatment of patients with relapsed mantle cell lymphoma (MCL).

Author | Andre Goy, MD

Articles

Dr. Goy on CAR T-Cell Therapy Updates in Non-Hodgkin Lymphoma

Dr. Goy on Promising Data With Acalabrutinib in MCL

Dr. Goy on Immunotherapy in Mantle Cell Lymphoma

Dr. Goy on the Combination of Biological Therapies in Relapsed MCL