Update on Use of Immunotherapy in Hematologic Malignancies - Episode 9
Early immunologic treatment approaches were largely ineffective in lymphoma; however, the incorporation of rituximab, a chimeric monoclonal antibody that targets CD20, represented an important advancement in the treatment of B-cell malignancies, comments Myron S. Czuczman, MD. Research today surrounding next-generation anti-CD20 monoclonal antibodies, such as obinutuzumab, ofatumumab, and ibritumomab tiuxetan, will help determine the relative efficacy and safety associated with these antibodies.
Brentuximab vedotin is an antibody-drug conjugate directed to the CD30 antigen that is approved for Hodgkin's lymphoma. This agent is now being evaluated for its role in the upfront setting or as a bridge to autologous or allogeneic stem cell transplantation among patients with Hodgkin's lymphoma who developed resistance or were not responding to therapy. Given its efficacy in later setttings, brentuximab vedotin is being considered as a substituion for bleomycin in the standard ABVD regimen.
In addition to monoclonal antibodies, newer technologies, including the chimeric antigen receptor T-cell therapies, have also been explored. These therapies are highly effective but expensive, notes Dan Douer, MD. The high cost of cancer care has become a matter of national and international debate. As a result, it is becoming increasingly important to determine the cost-effectiveness of these novel therapies.
One cost consideration is the duration of therapy, says Madhav V. Dhodapkar, MD. Many traditional therapies are part of a maintenance strategy and require long-term use, whereas immunotherapy may result in a durable response after being administered once or twice.
Defining cost extends beyond the administration of the drug to the patient, notes Ivan Marques Borrello, MD. The overall cost to society may be lower for a more expensive therapy if the treatment ultimately allows the patient to continue working for several more years, says Borrello.