I will present some of the current ongoing or future trials for further defining the role of immunotherapy in the field of B-cell precursor ALL. In particular there are now frontline randomised trials comparing either the addition of a course of blinatumomab or the substitution of two courses of consolidation therapy, in particular in the high risk patients, to address the question if the addition of immunotherapy is able to spare undue toxicity and also to improve the outcome of patients. These studies will certainly contribute to better define the role of blinatumomab, anticipating the utilisation of this type of immunotherapy in patients with newly diagnosed ALL.
I will also discuss what will be run in the future, the IntERALL trial. IntERALL is a network of centres belonging to the European countries but also having on board also other countries like New Zealand or Australia in which we want to optimise the rescue therapy of patients with acute lymphoblastic leukaemia failing frontline therapy. In particular, what will be the future trial is greater use of different forms of immunotherapy, including blinatumomab, the anti-CD22 antibody-drug conjugate inotuzumab, and also the role of CAR T-cells. CAR T-cells represent, together with blinatumomab, inotuzumab, the vanguard of immunotherapy. They have obtained outstanding results in patients with a very advanced form of the disease. Now the future challenge is that of testing the use of CAR T-cells in patients experiencing very high risk relapse for having a more comprehensive and better understanding of the different advantages and limitations of the available approaches of immunotherapy.
Where do you think we will be in 10 years’ time in terms of these advancements?
Of course in the next years we will use in the field of B-cell precursor ALL much more immunotherapy than chemotherapy. Chemotherapy has obtained fantastic results and allowing us to definitely cure around 85-90% of patients with B-cell precursor ALL. But these important results were obtained at the price of some toxicity, both in the acute and long-term, thus the idea is that further optimising the results that we have obtained and to reduce the risk of long term sequelae.