Developments in haematological malignancies
Dr Stephen Nimer - University of Miami, Miami, USA
This is a meeting that has a lot of solid tumour biology and solid tumour clinical therapy. As a haematologist I’m also very interested in what’s going on in leukaemia and there’s so much going on now in acute leukaemia - in AML in adults two exciting trials and also in CLL there has been a lot going on. I’m very much looking forward to one of the plenary sessions tomorrow of a monoclonal antibody therapy for multiple myeloma. Multiple myeloma is another disease where we’ve made great progress, even over the last twelve months.
Can we come back to AML for a second, what are you looking forward to there?
There’s a very interesting result that has come out of a medication that combines two drugs that have been given for four decades to treat AML, one drug called Cytarabine, or cytosine arabinoside, and another daunorubicin. This is a liposomal formulation of these two drugs in a fixed dose and, surprisingly, the data looks much better than when the drugs are given separately. So we’ve been trying for decades to make advances in treating AML in adults and this looks like it may be one of the first ones that will have broad applicability.
And on CLL, you mentioned there were developments there?
CLL there’s been a wealth of riches – oral agents and new monoclonal antibodies and people are being treated now for some very difficult to treat CLL. CLL, for instance with p53 mutations, tends to be what we call a bad actor to have a poor prognosis. So some of the data with ibrutinib looks like it’s going to make a real difference for people’s lives who have poor risk CLL. Now we have to figure out how to combine the different drugs and that’s the challenge for the field right now in CLL. But lots of new agents that affect signalling, the aberrant signalling in CLL, things that are either at the B-cell receptor level like ibrutinib and things that work downstream of BCR.
Lastly you mentioned the monoclonal antibody for multiple myeloma.
Yes, daratumumab has been FDA approved for treating advanced myeloma and we look forward to hearing of the movement of daratumumab more up front in combination with what is one of the standard therapies which would be an IMiD and steroids, so lenalidomide and dexamethasone with and without antibody.
With these upcoming results in mind is there anything that you think is going to be especially exciting for the near future or something that you’d like to see in the next few years, in the next few ASCO conferences?
One of the important areas in the haem malignancies has been how do you introduce immunotherapy. I heard this morning a very nice talk about combination immunotherapy of non-small cell lung cancer and for a variety of the solid tumours the approach has worked very well. In lymphoma this works well because of a genetic deletion and over-expression of the PD-L1 so that the antibody works extremely well in lymphoma. But we’re still trying in the myeloid malignancies and a few other conditions to introduce immunotherapy that could be effective. CAR T-cell therapy is the other, chimeric antigen receptor T-cells which work in the lymphoid malignancies. There’s some evidence they work in solid tumours and we’re still struggling in the myeloid malignancies to identify a good target.
Is there anything you’d like to say in conclusion to wrap everything up?
In conclusion, it’s a very exciting time to be in the field of oncology research. We are introducing precision medicine, one, to understand the tumours but also to understand what combination of therapies may be most effective in specific situations.