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Blood Cancers Video Library: CLL and Non Hodgkin Lymphoma: What new drugs are on the horizon and why are they exciting?

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GRACE joined a number of top faculty in the area of hematology in Whistler BC, for the 3rd Annual Summit on Hematologic Malignancies.  John Kuruvilla, MD, Associate Professor, Princess Margaret Hospital, University Health Network in Toronto, Canada, spoke with GRACE about Chronic Lymphocytic Leukemia (CLL) and Non Hodgkin Lymphoma, and discusses that we’re finally seeing the potential for the development of some new and innovative therapies, including immunotherapy, and using things like checkpoint inhibitors – the PD-1 antibodies like nivolumab and pembrolizumab, another class of antibody called BiTEs, antibody drug conjugates, (ADCs), and more.

 

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What new drugs are on the horizon and why are they exciting?

John Kuruvilla, MD, Associate Professor

Princess Margaret Hospital, University Health Network, Toronto Canada

 

I think it’s a very interesting time for patients with non-Hodgkins lymphoma, because we’re finally seeing the potential for the development of some new and innovative therapies. Traditionally, we’ve had a lot of ground that we’ve been able to accomplish with standard chemotherapy, particularly with the addition of rituximab-based combinations. We know that stem cell transplants clearly have a role, but over the next couple of years, I think we’re going to see a lot of exciting new developments.

First, the idea of immunotherapy, using things like checkpoint inhibitors – the PD-1 antibodies like nivolumab and pembrolizumab –have a lot of activity in Hodgkins lymphoma. We’ll need to see how those drugs perform in non-Hodgkins lymphoma, and they will probably have a role.

In terms of other antibodies, there are another class of antibody called BiTEs. These are Bi-specific T-cell engaging antibodies. They actually have two parts to them: one that can engage the tumor, and one that can attach to normal T-cells, which is the effector, the soldier of your immune system. They can bring the two of them together to the same party, and then have the soldier meet the enemy, and that seems to be a very winning strategy in ALL. We’re kind of seeing now with early days how that strategy will pay out in aggressive histology non-Hodgkins lymphomas. It will be another interesting sort of therapy that we’ll see available in the next little while.

Antibody drug conjugates, what we call ADCs, these are antibodies that have chemotherapy attached to them. It’s basically a smart bomb, it’s a way to deliver a payload targeted to the cancer cell. We’ve seen this proven in Hodgkins lymphoma with the treatment brentuximab, which is now a standard therapy in the relapsed setting, being evaluated in the front-line setting in combination with AVD. Again, these are treatments that look like they could be potentially quite promising in non-Hodgkins lymphoma, but we’ll just have to see how these things play out in the next little while.

I think lastly there’s a lot of excitement with two other broad classes. There are signaling pathway inhibitors that are looking at all sorts of novel pathways. Finally there are these things called CAR T-cells. This is an immunologic cellular treatment that takes an engineered cell product and infuses it back into the patient, so it’s their own cells that have been modified. They’ve seen some very exciting results in ALL and in CLL and we’ve seen some very early exciting results in lymphoma as well.

From my standpoint as a clinician treating lymphoma, it’s great to have a lot of potential new tools in the toolbox, and it’s great to see some very exciting and innovative clinical trials being done as great opportunities for patients when they need new options.

 

 

 

 

 


 

 

 


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