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Denise Brock

ASH 2016 Recap #4 Update on Antibody Therapies in Indolent Non-Hodgkin Lymphoma

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 Patient News
from the American Society of Hematology (ASH)
Annual Meeting 2016
Presented by the
Global Resource for Advancing Cancer Education
 
             

 
GRACE is pleased to present a series of webcasts with faculty member John Pagel, MD, PhD, DSc, from Swedish Cancer Institute. Dr. Pagel was one of many to attend the American Society of Hematology’s Annual Meeting (ASH) in early December 2016 and graciously sat down with GRACE to recap highlights from the meeting.  Our fourth video in this series updates us on antibody therapies in indolent non-hodgkins lymphoma.
 

View information about ASH

 
 

 


 

Please feel free to offer comments and raise questions in our Discussion Forums.


Transcripts will be available soon.  

 


We would like to thank the following companies for their support of this program:


 

 

 

 

 


Denise Brock

ASH 2016 Recap #3 Maintenance Therapy in Chronic Lymphocytic Leukemia

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 Patient News
from the American Society of Hematology (ASH)
Annual Meeting 2016
Presented by the
Global Resource for Advancing Cancer Education
 
             

 
GRACE is pleased to present a series of webcasts with faculty member John Pagel, MD, PhD, DSc, from Swedish Cancer Institute. Dr. Pagel was one of many to attend the American Society of Hematology’s Annual Meeting (ASH) in early December 2016 and graciously sat down with GRACE to recap highlights from the meeting.  Our third video in this series discusses maintenance therapy drugs in chronic lymphocytic leukemia, or CLL. 
 

View information about ASH

 
 

 


 

Please feel free to offer comments and raise questions in our Discussion Forums.


Transcripts will be available soon.  

 


We would like to thank the following companies for their support of this program:


 

 

 

 

 


Denise Brock

ASH 2016 Recap #2 – Update on New Chronic Lymphocytic Leukemia Drugs

Share
 Patient News
from the American Society of Hematology (ASH)
Annual Meeting 2016
Presented by the
Global Resource for Advancing Cancer Education
 
             

 
GRACE is pleased to present a series of webcasts with faculty member John Pagel, MD, PhD, DSc, from Swedish Cancer Institute. Dr. Pagel was one of many to attend the American Society of Hematology’s Annual Meeting (ASH) in early December 2016 and graciously sat down with GRACE to recap highlights from the meeting.  Our second video in this series gives us an update on new chronic lymphocytic leukemia drugs.
 

View information about ASH

 
 

 


 

Please feel free to offer comments and raise questions in our Discussion Forums.


  View/download transcripts here.


 

TRANSCRIPT

This is John Pagel, MD.  I am going to discuss some of the newer agents that were presented at the American Society for Hematology meeting in December 2016 in San Diego, California.   

These are newer agents in development and for therapy for patients with chronic lymphocytic leukemia or CLL.  A couple of new drugs are in advanced development that certainly are worthy of notice.  One of them is a drug that gained a lot of attention at the ASH meeting in 2015 and now has been updated in a couple of studies in 2016, and that is a drug that is called acalabrutinib. 

Acalabrutinib is a second generation inhibitor of an enzyme known as Bruton’s Tyrosine Kinase or BTK.  It turns out, of course, that BTK, is a target of the 1st generation BTK inhibitor known as ibrutinib.  Again, acalabrutinib was presented at the ASH meeting in 2015 showing excellent activity with very few adverse events and to be very well tolerated. 

Now it was updated in a couple of studies.  One study, of particular note, was a study of patients who were intolerant to ibrutinib.  Many of those patients could go on to acalabrutinib and actually have a response that was maintained and the side effects they had that may have been important for them coming off of treatment with ibrutinib were not found when they switched over to acalabrutinib.  This was a study led by Baruke Awan from Ohio State University.  I think that this is very important to know, that if side effects drive people away from a drug that is working, there is another drug that may be in pipeline on the horizon for people that works in exactly the same way but may not have the side effects. 

Acalabrutinib was also looked at and presented in a study by Peter Hellman, looking at the worst types of patients with CLL and that may have a transformation of their disease to a more aggressive form.  That is something we call a Richter’s transformation.  That was presented at the meeting and the results were quite impressive in very, very difficult patients, patients who had very advanced disease and, again, had had their disease transform to a more aggressive form.  Again, acalabrutinib is in advanced development.  I would say that we need, of course, more time to follow-up on these patients and use of acalabrutinib but, in particular, in these settings for patients with disease that is intolerant to ibrutinib or, perhaps, have become more aggressive, people can actually have significant benefit. 

I will also touch on the very important drug, known as TG-1202, which was presented extensively at the meeting.  TG-1202 is a very exciting drug in that it is another second generation drug from one that we already have approved for patients with CLL.  TG-1202 is a tyrosine kinase inhibitor and a second generation.  Second generation being that it is perhaps a new and improved version of the previously approved first generation drug known as idelalisib. 

TG-1202 suggests that it may not have the same aggressive toxicity profile that, albeit rarely, we do see with idelalisib. Particularly, perhaps we will see less diarrhea, less pneumonitis or pneumonias or lung inflammation, and, perhaps, less inflammation in the liver.  This drug has continued in development and we are very excited to see where that leads us in the next game changing type of drug. 

Of course, I should point out that these agents aren’t all by themselves.  We like to combine them in many ways and combinations are certainly the way to go in the future.  In particular, and I will mention a very important study that was led by Jeff Jones of Ohio State University and also presented at ASH, that used a combination of drugs known as obinutuzumab, ibrutinib, and venetoclax.  I have already mentioned the ibrutinib which is a BTK inhibitor.  Obinutuzumab is a newer generation anti-CD20 antibody that has excellent activity and venetoclax is new drug that targets a protein known as Bcl-2 and this actually induces cell death in the CLL cell.  So the combination, again, of the obinutuzumab, ibrutinib, and venetoclax was used in a small trial, relatively few patients, but still shows that this combination can be very well tolerated and that the side effects are very manageable and that the efficacy or the activity is quite impressive.  Everybody who was treated showed a response and, in fact, many of these patients got complete remissions at a very short follow-up.  Furthermore, many of these patients had elimination of, what we call, minimal residual disease, either in their blood or bone marrow or both.  Minimal residual disease clearance is very important for extending, what we call, progression-free survival.  This is looking down at very deep level to see if we have eliminated any of the CLL cells.  It is a method to actually make sure that in the blood and marrow, we have done an excellent job of controlling the disease. 

Other combinations are in development and, just for completeness sake, I will mention that there are trials in development using all kinds of combinations and the TG-1202 trial is certainly in development and in combination, as well, and we will see more about that as we move forward.  It is a very exciting time for these new drugs in CLL, not only as single agents but in combinations. 

 


We would like to thank the following companies for their support of this program:


 

 

 

 

 


Denise Brock

ASH 2016 Recap #1- Long Term Follow-up with Ibrutinib in Chronic Lymphocytic Leukemia Patients

Share
 Patient News
from the American Society of Hematology (ASH)
Annual Meeting 2016
Presented by the
Global Resource for Advancing Cancer Education
 
             

 
GRACE is pleased to present a series of webcasts with faculty member John Pagel, MD, PhD, DSc, from Swedish Cancer Institute. Dr. Pagel was one of many to attend the American Society of Hematology’s Annual Meeting (ASH) in early December 2016 and graciously sat down with GRACE to recap highlights from the meeting.  Please enjoy our first video in this series, discussing long-term follow-up with ibrutinib in chronic lymphocytic leukemia (CLL) patients.    
 

View information about ASH

 
 

 


 

Please feel free to offer comments and raise questions in our Discussion Forums.


View/download transcripts here.  


TRANSCRIPT

This is John Pagel, MD.  I am going to now give an update on some of the newer agents for chronic lymphocytic leukemia that were discussed and presented at the American Society for Hematology meeting in December in San Diego, California. 

Of course, this is the largest meeting on agents that are in development for use for patients with blood cancers and, in particular, I am focusing here on chronic lymphocytic leukemia or CLL. 

We certainly know that one of the most important drugs that we have had in the last couple of years has been a drug well known as ibrutinib.  Ibrutinib has been one of those game changer drugs, paradigm shifting drugs, such that it has evolved away from extensive use of chemotherapy in many patients, perhaps older patients who would not tolerate them very well, and we had a presentation at ASH. 

The meeting showed an update on the longest trial ever done on ibrutinib.  This is five-year follow-up data with many patients who were remaining on the drug.  A very important study led by Susan O’Brian and her colleagues, which showed that many people could stay on the drug, ibrutinib, for a very prolonged period of time.  Again, there are some people that have now been on the drug for many years and are tolerating it extremely well.  There has always been a question if this agent would hold up over time and be able to be something that people could remain on without any difficulties. 

Now not everybody, of course, is able to remain on the drug.  We do know that some people will have to come off therapy because of some intolerance.  Typically, that might be arthralgias, which are aches or pains of muscles or joints.  We do know that sometimes bleeding can be a slight issue or even a rapid or abnormal heart rhythm such as atrial fibrillation but those things are very, very rare and, in fact, the vast majority of patients can do extremely well with the drug for a long period of time and, in particular, the small number of people who were on this initial study who were put on ibrutinib as their first line treatment. 

People were able to stay on the drug for a long period of time and, again, five-year follow-up data is extremely encouraging with the vast majority of patients not relapsing and patients remaining alive, doing well and having excellent control of their chronic lymphocytic leukemia.


 

We would like to thank the following companies for their support of this program:


 

 

 

 

 


Denise Brock

Blood Cancers Video Library: Lymphoma – Is there still a role for chemo?

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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.  Andrew Zelenetz, MD, PhD, Vice Chair Medical Informatics, Department of Medicine and Medical Director, Memorial Sloan Kettering Cancer Center, talks with GRACE about Lymphoma, and if there is still a role for chemo.Andrew Zelenetz

 

 We invite you to watch this and other videos from our Blood Cancers Library Video collection

Stay tuned for more educational videos!

 

 


 

Please feel free to offer comments and raise questions in our Discussion Forums.


TRANSCRIPT 

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Lymphoma – Is there still a role for chemo?

 
Andrew Zelenetz, MD, PhD
Vice Chair Medical Informatics, Department of Medicine and Medical Director
Memorial Sloan Kettering Cancer Center

 

On March 4, 2016, the FDA approved the use of ibrutinib as first-line therapy in patients with chronic lymphocytic leukemia. And this has raised the question in many patients: What is the role, if any, of conventional chemotherapy in the management of the disease? First we have to look at the question of what was actually studied in the patients who were on the RESONATE-2 trial which compared cholorambucil, a treatment that is largely not used by itself any more in the United States, and compared it to ibrutinib. It is clear that the patients treated with ibrutinib had a very significantly improved progression-free survival, that is, time until the disease started to progress. And they had a better overall survival, in part an artifact of the very poor activity associated with chlorambucil, which is why we don’t routinely use this in clinical practice. This trial is a good example of one which was done to clearly identify the role of ibrutinib for regulatory purposes, but was actually less helpful for us to help drive clinical decisions. 

I believe that the older patient, the frail patient, the patient with deletion chromosome 17p, probably will benefit from treatment with single-agent ibrutinib as up-front treatment. However, this is chronic therapy (patients are on therapy for a long time) and there is a risk of toxicity developing during the course of treatment. Furthermore, the RESONATE-2 trial has very limited follow-up so far. 

So for the patient in whom chemotherapy is appropriate today (in 2016), because it remains time-limited and we don’t know if there is a clear survival advantage in starting with ibrutinib, I feel that starting with chemo-immunotherapy is still a very reasonable choice. These are discussions that need to be had between the patient and their treating doctor.


 

 

 

 

 


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