Press briefing

At the press breifing on June 11th at the EHA meeting in Barcelona, two exciting developments were presented in the areas of lymphoma and leukaemia.

Dr Gilles Salles presented data from the PRIMA study, which investigated 2-year maintenance therapy with rituximab in patients with follicular lymphoma. The study was conducted in 25 countries in almost 1200 patients. Post-induction therapy patient were randomised to observation or rituximab maintenance (375 mg/m2 IV every 8 weeks) for 2 years. A significant improvement was seen in the primary endpoint, progression free survival, which was independent of the age of the patient, FLIPI score and response after induction. Additionally, time to next anti-lymphoma treatment and time to next chemotherapy were also significantly improved. Importantly, there were no observed differences in quality of life assessment scores between patients on rituximab maintenance and those observed only. Discontinuation rates were low, with infection and neutropenia the most commonly reported adverse events. The conclusions taken from this study are that 2-year rituximab maintenance therapy after immunochemotherapy should be considered as a new standard of care in follicular lymphoma patients in need of treatment.

Professor Steve Baylin, who is one of the pioneers in the field of cancer epigenetics , explained the role of epigenetic regulation in haematological cancers. Abnormal silencing of genes plays a surprisingly major role in the biology of human cancer, from initiation through progression. This pathway to loss of gene activity constitutes an alternative way for mutations to disrupt proper protein function. Since the primary DNA structure of the affected genes is normal, unlike for mutated genes, reversal of the abnormal DNA methylation at the gene start sites provides a means to readily restore normal function to affected cancer genes. DNA methyltransferase inhibitors and histone deacetylase (HDAC) inhibitors are two pharmacological modulator classes that have been developed as potential epigentic therapy for patients with haematological cancers. Azacitidine was the first of these modulators, initially developed in the 1960s. Incorporation of azacitidine into DNA or RNA inhibits methyltransferase thereby causing demethylation and subsequently affects the way that cell regulation proteins are able to bind to the DNA/RNA. At lower, less toxic doses that those initially used in cytotoxic chemotherapy, azacitidine has exhibited robust and durable responses in patients with myelodysplastic syndromes. Methyltransferase inhibitors have also been investigated in leukaemias and myeloproliferative disorders and studies are currently ongoing to investigate their potential role in the treatment of solid tumours. Early results in patients with advanced lung cancer have been very encouraging and will be published shortly. Additionally, their use as maintenance and sensitisation therapy are also being investigated.

By Vanessa Lane