As the 61st Annual ASH (American Society of Hematology) Meeting and Exhibition winds down here in Orlando, here are some thoughts on where things stand in the world of blood cancers.
New targeted therapies approved in just the past two years alone are making precision medicine more of a reality for acute myeloid leukemia (AML). As I noted in a previous blog our own Amy Burd, Ph.D., LLS vice president of research strategy, presented compelling data that precision medicine, giving a patient a drug based on their molecular profile rather than one-size fits all, is bringing a paradigm change in how AML patients will be treated moving forward.
For patients with chronic lymphocytic leukemia (CLL), we’re seeing a decided shift toward chemo-free combinations of targeted medicines, opening a debate about whether the old standard, chemotherapy plus an antibody, will be replaced by a new regimen. Studies are showing that combinations of targeted therapies that work by blocking the activity of bad-acting genes, proteins or cellular pathways are quickly pushing their way to the front of the line for treatment of CLL. One study presented at the meeting showed that two targeted oral therapies given together, venetoclax and ibrutinib, resulted in deep remissions for CLL patients, with 75% having high rates of undetectable minimal residual disease, meaning no traces of cancer cells could be found with highly sensitive tests. LLS didn’t fund this study, but has invested millions over two decades to advance both of these therapies.
Further, with the advent of CAR T-cell immunotherapy and bispecific antibodies, both once the stuff of science fiction but now increasingly becoming mainstays of treatment with remarkable results, it’s clear we are experiencing a seismic shift in the standard of care for many patients with leukemia, lymphoma and myeloma.
Since coming on the scene, CAR-T has emerged as a miracle treatment that has brought patients from the brink of death to enduring remissions. But CAR-T doesn’t work for everyone and even many patients who initially respond, can relapse.
Enter mosunetuzumab. This new investigational drug is considered so game-changing for patients whose lymphoma has returned following treatment that it was featured during the plenary session, held in the biggest hall in the conference center to accommodate thousands of attendees. Mosunetuzumab is a bispecific antibody, meaning it binds two proteins, one on the surface of tumor cells (CD20) and the other on the surface of the recipient’s T cells (CD3).
The data presented in the plenary showed that of 124 patients with fast moving, aggressive lymphomas, 46 patients (37%) saw a decrease in the amount of cancer, with 24 (19%) achieving complete remission. Those with less aggressive disease still saw results; a reduction of disease was seen in 42 patients (63%), with 29 (43%) achieving complete remission as well. Among 18 patients whose lymphoma progressed after treatment with CAR-T, 22% experienced complete remissions. The remissions for these patients appear to be long-lasting.