In the final episode of Season 3 we journey to Atlanta, Georgia for the 2017 American Society of Hematology (ASH) annual meeting to learn more about the latest developments in hematologic malignancies, including leukemias, lymphomas and multiple myeloma.
Contrary to popular perception, it isn’t always warm and sunny in the southern states – Brrrr!:
For this episode, we interviewed an eclectic line-up of experts, some of whom abandoned the rose tinted glasses to take a more honest and realistic approach to oncology R&D:
Dr Paul Richardson (Dana-Farber Cancer Institute, Boston) is the Director of Clinical Research at the Jerome Lipper Multiple Myeloma Center with a keen interest in studying the use of combination therapies predominantly in relapsed and refractory myeloma as well as exploring ways to reduce regimen-related toxicities.
In this episode, Dr Richardson discusses the differences between clinical trial and real world experiences, as well the importance of tolerability in chronic conditions such as myeloma (Abstracts # 3149 and # 1855).
He thoughtfully explains the challenge associated with toxicities when two potent immunotherapies such as checkpoint blockade plus IMiDs are given concurrently, following the FDA clinical hold on several industry studies.
Dr Philippe Armand (Dana-Farber Cancer Institute, Boston) is the Director of Clinical Research for the Lymphoma Program and has participated in clinical trials involving both immune checkpoint blockade and CAR T cell therapies for classical Hodgkin lymphoma and Non-Hodgkin lymphoma, respectively.
We recorded this interview at the BMT Tandem meeting in 2016, where he highlighted a very important, yet little discussed topic, namely the challenges associated with combining immunotherapies and in particular, the unfortunate toxicities that can result if given after allogeneic stem cell transplantation for Hodgkin lymphoma.
Given the subsequent findings in myeloma with checkpoint therapy combinations that Dr Richardson kindly highlighted, Dr Armand’s warning that we could be ‘playing with fire’ seems a rather prescient and apt phrase in retrospect!
AML and MDS
Acute myeloid leukemia (AML) and high risk myelodysplastic syndrome (MDS) can be challenging diseases for hematologists if there is relapse post stem cell transplant (SCT) since there have been few new approaches approved over the last decade or so with an often poor prognosis.
There are also few effective and tolerable options for elderly, frail patients who are not SCT eligible and many molecules have ended up in the Pharma graveyard of failed trials.
Dr Nancy Simonian (Syros) explains why and how a new targeted approach that is in development might be useful when combined with existing approved therapies (See: Abstract # 2633 and Abstract # 2651).
We welcome back Dr Deepak Sampath (Genentech) – he last appeared in Episode 6 with the late Dr Holbrook Kohrt (Stanford).
This time around he continues the story of his preclinical research on venetoclax, a BCL–2 inhibitor.
The discussion now extends beyond CLL to look at their efforts to explore additional hematologic malignancies in order to understand how basic research can help us understand how to pair the right patients with the right drug combinations.
Here’s the link to his new Cancer Discovery paper referred to the podcast.
Dr Ian Flinn (Sarah Cannon Research Institute, Nashville) previously appeared in Episode 10 back in the first season of the podcast discussing new developments and the potential for financial toxicity in CLL.
Since then, there have been quite a few changes to the disease landscape, not to mention a raft of new data emerging with different combinations.
This time around he discusses the MURANO trial presented in the late breaking abstract session on the final day of ASH (Abstract # LBA-2).
This study explored the combination of venetoclax plus rituximab (VR) versus the standard approach of bendamustine plus rituximab (BR) and considers whether the results are practice changing or not.
Last season in Episode 16 on Controversies in Hematology last season, Dr John Leonard (Weill Cornell) had fun explaining his selections and choices for #LeoardList at #ASH16.
He’s graciously back for a return in the hotseat, but this time we focused on key issues and challenges with some hard hitting and honest feedback on various developments in CAR T cell therapies in DLBCL (e.g. Abstract # 577, Abstract # 578, Abstract # 579).
There’s also a candid review of the data presented in the plenary session from the ECHELON–1 study with the CD30 directed ADC, brentuximab vedotin given in combination with standard chemotherapy in the front-line setting for Hodgkin lymphoma (Abstract # 6). Dr Leonard discusses the impact of the 2016 RAHL study on these results.
Dr Michael Wenger (Genentech) also appeared in Episode 16 discussing the CD79b directed ADC, polatuzumab vedotin in advanced NHL.
A lot has happened since then and it’s time for a new update on a randomised phase 2 clinical trial where the molecule was added to standard bendamustine plus rituximab (BR) therapy and compared to the BR doublet to see if response rates and outcomes could be improved or not (Abstract # 2821).
Dr Wenger discusses the data presented by Dr Laurie Sehn and also candidly explains what the implications of their clinical findings are.
Genentech sponsored this episode of Novel Targets – we’re grateful for their continued support.
Instead of a formal advertisement or reading a corporate message, we offer listeners mini interviews or vignettes with scientists and physicians to showcase their research. In this show, that honour went to Dr Deepak Sampath.