Hagop Kantarjian, MD
The anti-CD19 agent blinatumomab (Blincyto) received an accelerated approval from the FDA in December 2014 as a treatment for patients with Philadelphia chromosome-negative (Ph-) relapsed/refractory B-cell precursor acute lymphoblastic leukemia (ALL).
, Kantarjian, professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discussed the success of blinatumomab and next steps with the anti-CD19 agent.
OncLive: Please provide some background on your research.
In ALL, we can cure, at best, 40% to 50% of patients—and that requires intensive chemotherapy that lasts for about 3 years. It is intensive, it is toxic, it is long, and it is associated with long-term complications. The monoclonal antibody therapy is going to be a breakthrough for adult ALL. The first breakthrough was with rituximab (Rituxan), the CD20 monoclonal antibody—when we add it to chemotherapy, it improved all comers. So, this was something that we piloted in 2002, and it was confirmed in randomized studies by the French more recently, in 2012 and 2014.
Another monoclonal antibody which is different—it is not specific; it is attached to a chemo-toxic—is called inotuzumab ozogamicin. We did a similar study with that, which was a randomized study of inotuzumab versus chemotherapy. It showed very similar data in terms of improving survival and improving response rates.
What are the next steps with blinatumomab?
The next steps are to move it to the frontline. We know if ALL patients have MRD in first remission, their outcome is bad. By giving them blinatumomab, we can render 80% of them MRD negative, and their survival is significantly better than the historical data. So, I think now we should move blinatumomab into the frontline setting with chemotherapy and in the salvage setting, we should combine it with chemotherapy, too.
Do you think that this means the standard of care will change in the next 5 to 10 years?
Very much so. I think what we are seeing is a slow-motion evolution in the treatment of adult ALL, like we saw with chronic myeloid leukemia (CML) in 2000 with the tyrosine kinase inhibitors, and like we are seeing in chronic lymphocytic leukemia with the B-cell receptor inhibitors and venetoclax (Venclexta). Also, it is much like what we are seeing in the solid tumors with immunology studies with checkpoint inhibitors.
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