Lymphoma highlights from ASCO annual meeting 2017

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Published: 21 Jul 2017
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Dr Eduardo Sotomayor - George Washington Cancer Center, Washington, USA

Dr Sotomayor talks with ecancer at the Best of ASCO 2017 meeting in Miami about the highlights from the ASCO annual meeting in the field of lymphoma. He discusses two abstracts with long term follow up of patients treated for follicular lymphoma, the first is the phase 3 study evaluating the efficacy and safety of bendamustine plus rituximab verses a standard rituximab-chemotherapy regimen, the BRIGHT study. The second is a phase 3 study looking at bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment, the StiL study.

For more information on recent developments in lymphoma treatment watch ecancers coverage of the EHA conference here

Today I’m going to present a summary of the best of ASCO in the field of lymphomas. Basically today I’m going to focus on three areas, a total of four abstracts that were presented at ASCO that according to the people that attended were considered to be the best. The first area is in the follicular lymphoma field and there were two abstracts with long-term follow-up of patients treated with chemo-immunotherapy. The first one was the BRIGHT study that compared a combination of bendamustine rituximab versus CHOP rituximab and CVP rituximab. So this study shows an improvement in progression free survival in those patients that received bendamustine with rituximab. However, there was no difference in overall survival and there was an increased incidence of secondary malignancies in those patients that received bendamustine rituximab.

The second study is a German study named the StiL study, also comparing in this case bendamustine rituximab versus R-CHOP and this is a nine year follow-up. In this study that was initially presented several years ago the long-term follow-up data shows again a significant improvement in progression free survival in those patients that received bendamustine rituximab as compared to CHOP-R. So in this study again there was no improvement in overall survival but they didn’t see any difference in secondary malignancies in those patients treated with bendamustine rituximab versus R-CHOP.

So the conclusion of both studies is that in those patients with follicular lymphoma that have disease that needs to be treated bendamustine rituximab is still a very good option. The role of maintenance following bendamustine rituximab hasn’t been fully determined so some will use maintenance but some will prefer not to use maintenance and there is no right or wrong answer. Alternatively, the other conclusion is that you can still use R-CHOP plus or minus maintenance rituximab and since the maintenance rituximab is an equalizer it’s going to help in terms of clinical outcomes to those patients that receive induction with CHOP rituximab.
The second area that I’m going to be discussing today is in the area of aggressive lymphomas and one of the questions that we always have is what to do with those patients with large cell lymphoma that have bulky disease and at the end of treatment there is evidence of a residual mass. In the past for those patients we have done radiation therapy following six cycles of R-CHOP or other chemo-immunotherapy regimes but in this study the conclusion of this study was that in those patients that after six cycles of treatment the PET scan is negative you can spare radiation. In other words, after six cycles of treatment if PET is negative there is no need for radiation treatment. In those patients that after six cycles of treatment the PET is still positive this study also shows that if you give radiation therapy to those sites of bulky disease shows you can improve the outcomes of those patients.

Lastly, so the third area that I’m going to discuss is related to using genetically modified T-cells, in this case chimeric antigen receptor T-cells. There are different platforms, there are the platforms from the companies Kite, Novartis and Juno. At ASCO June 2017 Juno presented an update of their clinical trial using the anti-C19 CAR T-cells in 28 patients and in all those 28 patients there was an overall response rate of 80%, a complete response rate of 60% and these are patients heavily pre-treated, highly refractory. As shown by other groups, the study by Juno confirmed the high efficacy of using CAR T-cells. As most of us know, these CAR T-cells are associated with toxicity and in the Juno trial they saw the same toxicity although less intense – neurotoxicity, cytokine storm – as compared with other clinical trials using different platforms of CAR T-cells.

So I think it was a very good ASCO meeting and I am happy to be here to share these advances with people attending this meeting in Miami.