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Advances and Research Needs in Lymphoma

Insights From: Stephen M. Ansell, MD, PhD, Mayo Clinic; Radhakrishnan Ramchandren, MD, Wayne State University School of Medicine
Published: Friday, Jan 26, 2018



Radhakrishnan Ramchandren, MD: The treatment of lymphoma in 2018 is very different than it was 5 years ago. There has been an explosion of very active agents in lymphoma. These agents are now being utilized not only in patients who have relapsed disease but also are being brought to the front- and second-line setting. We hope that this will lead to more cures in patients with many types of lymphoma.

Ultimately, these drugs are aimed at improving cure rates. They are also aimed at lowering or reducing side effects in patients with lymphoma to make therapy more tolerable. They also result in patients who are free from their lymphoma without subsequent lines of therapy. The number of drugs that have been observed to have activity in lymphoma is at the highest level it has ever been. The future of lymphoma therapy is very bright, moving forward, as a result.

Stephen M. Ansell, MD, PhD: I think it’s really exciting right now. There are multiple new agents. There are multiple new tools. There are immunotherapies. There are CAR T cells. All of these are now available, and I think our challenge is to work out 2 things. First, we need to figure out how we can combine them, potentially, for greater efficacy. Or, how should we sequence them so that we utilize them in the most effective fashion? I think future studies are going to look at combinations of agents, such as immunotherapy agents and CAR T cells, with standard chemotherapy. Other studies will look at whether you should do one thing first versus others.

Looking to see whether certain agents can actually replace standard approaches—for example, looking to see if CAR T cells can replace the use of autologous stem cell transplantation—is being tested in a randomized trial. Those results are going to be very, very interesting.

One of the further challenges is determining how we can really identify who benefits from what therapy. Although there are some biomarkers that show some promise, we really haven’t worked out all of the biomarker data the way that we should. As we are realizing that therapies and agents are clinically useful, the challenge is going to be, can we identify the patients for whom it is the most useful and thereby really allow us to move the field forward in a substantial fashion?

Radhakrishnan Ramchandren, MD: The advances in the treatment of lymphoma have largely been fueled by clinical trials. The role of clinical trials in developing new drugs and finding new standards of care for lymphomas cannot be underestimated or underemphasized. Patients who have lymphoma and have been diagnosed with lymphoma should consider an opinion from a physician to discuss clinical trials. Many of these trials involve standard therapies that patients would get anyway, but may add additional drugs that have the potential to provide additional benefit for patients with lymphoma.

So, in my opinion, getting evaluated and understanding clinical trials is critical for anyone with cancer. But, particularly given the landscape in lymphoma, they are important in lymphoma at this time.

Transcript Edited for Clarity
 
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Radhakrishnan Ramchandren, MD: The treatment of lymphoma in 2018 is very different than it was 5 years ago. There has been an explosion of very active agents in lymphoma. These agents are now being utilized not only in patients who have relapsed disease but also are being brought to the front- and second-line setting. We hope that this will lead to more cures in patients with many types of lymphoma.

Ultimately, these drugs are aimed at improving cure rates. They are also aimed at lowering or reducing side effects in patients with lymphoma to make therapy more tolerable. They also result in patients who are free from their lymphoma without subsequent lines of therapy. The number of drugs that have been observed to have activity in lymphoma is at the highest level it has ever been. The future of lymphoma therapy is very bright, moving forward, as a result.

Stephen M. Ansell, MD, PhD: I think it’s really exciting right now. There are multiple new agents. There are multiple new tools. There are immunotherapies. There are CAR T cells. All of these are now available, and I think our challenge is to work out 2 things. First, we need to figure out how we can combine them, potentially, for greater efficacy. Or, how should we sequence them so that we utilize them in the most effective fashion? I think future studies are going to look at combinations of agents, such as immunotherapy agents and CAR T cells, with standard chemotherapy. Other studies will look at whether you should do one thing first versus others.

Looking to see whether certain agents can actually replace standard approaches—for example, looking to see if CAR T cells can replace the use of autologous stem cell transplantation—is being tested in a randomized trial. Those results are going to be very, very interesting.

One of the further challenges is determining how we can really identify who benefits from what therapy. Although there are some biomarkers that show some promise, we really haven’t worked out all of the biomarker data the way that we should. As we are realizing that therapies and agents are clinically useful, the challenge is going to be, can we identify the patients for whom it is the most useful and thereby really allow us to move the field forward in a substantial fashion?

Radhakrishnan Ramchandren, MD: The advances in the treatment of lymphoma have largely been fueled by clinical trials. The role of clinical trials in developing new drugs and finding new standards of care for lymphomas cannot be underestimated or underemphasized. Patients who have lymphoma and have been diagnosed with lymphoma should consider an opinion from a physician to discuss clinical trials. Many of these trials involve standard therapies that patients would get anyway, but may add additional drugs that have the potential to provide additional benefit for patients with lymphoma.

So, in my opinion, getting evaluated and understanding clinical trials is critical for anyone with cancer. But, particularly given the landscape in lymphoma, they are important in lymphoma at this time.

Transcript Edited for Clarity
 
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