Treatment of Ph-negative ALL in adolescents and young adults

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Published: 23 Jan 2020
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Dr Josep Ribera - Catalan Institute of Oncology, Barcelona, Spain

Dr Josep Ribera speaks to ecancer at the 2020 ALL Assembly meeting about the treatment of Ph-negative ALL in adolescents and young adults.

He believes that treatment with chemotherapy has reached its maximum potential and that the way forward has to be the integration of immunotherapy and targeted therapies with the chemotherapy.

Dr Ribera expects that 5 years from now we will start to see the results from clinical trials looking at these strategies.
 

Adolescents and young adults are a special population for ALL for two reasons – the disease, the disease is different from children and for older adults, and also by the results of the therapy, the results are not so good as children and are better than older adults. But we need to improve in this special population and there are some ways to do it currently.

What are some of the ways that we can improve treatment of Ph-negative ALL in adolescents and young adults?

We have reached the top with the standard chemotherapy so we can make just little improvements in the current chemotherapeutic drugs. We need, and we are doing this, the integration of this chemotherapy plus immunotherapy and targeted therapy. The integration of these three ways in good designed trials, I think that will lead to an improvement of the survival in this special population.

Have there been any recent studies looking into these combinations in this population?

There are several studies both in Europe, both in the US, integrating these kinds of therapies, so especially the use of immunotherapy in early phases of the disease. And, if we can, we can use also targeted therapy and these targeted therapies just are only possible in a subset of ALL currently. But in the near future also the targeted therapy will be improved and we will have a broad use of this strategy.

Where do you see treatment 5 years from now?

I think that in the next 5 years we will begin to see the results of these strategies. We need time and we need time to improve results that are improvable, are not bad but are not good, but they are in the range of 70% of survival. To increase this is difficult because we are getting from a high level but I think that in the next 5 years we will see perhaps a 10-15% improvement of our current results.

The key message is that we have to include this population in well-designed clinical trials because if we treat as our thinking we will never demonstrate anything. We have to include in well-performing clinical trials that currently most of the study groups have clinical trials for this specific population.

I want to send an optimistic message. There is room for improvement and improvement is ongoing.