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At the 63rd American Society of Hematology (ASH) Annual Meeting and Exposition, ECOG-ACRIN researchers reported seven treatment and quality of life discoveries for patients with blood or bone marrow cancers. The ASH meeting was held in Atlanta and virtually December 11-14. Below are summaries of the presentations.
Acute Lymphoblastic Leukemia (ALL) – An update from an active clinical trial.
- First author: Neil Palmisiano, MD (Thomas Jefferson University). Even though chemotherapy treatments lead to remissions in greater than 90% of adults with ALL, the majority will experience relapse. After relapse, the current strategy is additional chemotherapy aimed at complete remission so that the patient may receive a stem cell transplant to replace diseased cells with healthy ones. Unfortunately, only 20% to 30% of cases go into complete remission, leaving many people without the option of a transplant. These patients need better therapies. Study EA9152 is testing the addition of venetoclax, a targeted therapy, to liposomal vincristine (L-VCR) chemotherapy. Here, researchers report the results of the safety study in 18 patients. The combination of venetoclax with liposomal vincristine chemotherapy was safe for patients. In addition, researchers set the maximum tolerated dose. Now, clinical sites in the United States are actively enrolling patients in the phase II portion of the trial. Patients and physicians are encouraged to consider participating. Follow this link to Abstract 3407.
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Acute Myeloid Leukemia (AML) – Physically fit older adults with AML may be good candidates for a stem cell transplant.
- First author: Yishai Ofran, MD (Shaare Zedek Medical Center in Jerusalem). The most effective treatment strategy for adult patients with AML who go into remission after chemotherapy is a stem cell transplant to replace harmful stem cells with healthy ones from a donor. However, the toxicity associated with a transplant is a barrier to its routine use in older adults. This sub-study from a large randomized clinical trial (E2906) looked at outcomes from this treatment strategy in a group of physically fit adults age 60 and above. A high portion survived with no signs of leukemia for two, three, and even four years after transplant. Using the ECOG Performance Status scale, patients were physically fit if their score was zero (fully active without restrictions) or one (able to walk and carry out light tasks though restricted from physically strenuous activity). Follow this link to Abstract 413.
Acute Myeloid Leukemia (AML) – Adult survivors of AML have a shorter life expectancy regardless of their age, gender, or whether or not they had a stem cell transplant.
- First author: Chezi Ganzel, MD (Hebrew University of Jerusalem). Previous studies have shown that adults with AML who remain in long-term remission after a stem cell transplant have a shorter life expectancy than the general population. However, we know very little about the survival of those treated without a transplant. Now, ECOG-ACRIN researchers have generated the first data on the life expectancy of adults with AML who did not undergo a transplant, using life table data from the US Centers for Disease Control and Prevention. They found that patients without a transplant had shorter survival when compared to the general population, regardless of their age or gender. Follow this link to Abstract 690.
Chronic Lymphocytic Leukemia (CLL) – Patients age 70 and younger with CLL had a good quality of life during and after treatment with ibrutinib-rituximab.
- First author: Priyanka A. Pophali, MD (University of Wisconsin). The FDA approves using ibrutinib and rituximab in combination for the frontline treatment of patients age 70 and younger with CLL. This approval is based on the randomized phase III trial E1912. Not only did E1912 find that ibrutinib-rituximab provides better leukemia control, but it also prolongs life and has fewer side effects than previous standard chemotherapy plus immunotherapy (Shanafelt TD N Engl J Med 2019). As a result, E1912 eliminated the need for chemotherapy in these patients. However, it is important to measure the quality of life of patients who received ibrutinib-rituximab because they take this therapy continuously for several months. Here, E1912 researchers measured physical well-being, ability to carry out daily life, and other patient-reported outcomes (PRO) data. Trial participants experienced an improvement in their quality of life during the ibrutinib-rituximab treatment. In addition, their quality of life was maintained throughout therapy and afterward. This finding supports the frontline use of ibrutinib-rituximab therapy in previously untreated younger patients with CLL. Follow this link to Abstract 1562.
Chronic Myeloid Leukemia (CML) – An update from an active clinical trial.
- First author: Amer M. Zeidan, MBBS (Yale University). Most patients manage CML with life-long tyrosine kinase inhibitor (TKI) therapy, but it can be associated with chronic toxicities and substantial financial costs. Only a minority of patients are candidates for discontinuation of TKI therapy. Of those, most still relapse and must restart TKI therapy. The phase II BLAST MRD CML 1 trial (or study EA9171) is currently testing the addition of the anti-PD-1 antibody pembrolizumab to TKI therapy. It will also measure whether the combination increases conversion rate to undetectable minimal residual disease (MRD). Early results show that adding pembrolizumab to TKI therapy is safe and well-tolerated in these patients. Physicians are encouraged to consider participating in this trial. Follow this link to Abstract 3613.
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Follicular Lymphoma – For patients with previously untreated, slow-growing follicular lymphoma, treatment with rituximab alone is highly effective at delaying chemotherapy.
- First author and chair of the ECOG-ACRIN Lymphoma Committee: Brad S. Kahl, MD (Washington University in St. Louis). A watch and wait strategy is typical for this indolent, low tumor burden cancer, and three years is the average time before patients begin chemotherapy. The FDA approves the use of rituximab, a targeted drug, either alone or in combination with chemotherapy or other drugs to treat adults with this type of cancer. Here, researchers provide long-term survival outcomes from patients who participated in the randomized phase III RESORT trial (or study E4402), which compared two dosing strategies using rituximab rather than the watch and wait approach. First, previously untreated trial participants received a dose of rituximab every week for four weeks. Then, patients whose cancer responded to the treatment were randomly assigned to one of two treatment groups. One group received rituximab every three months. The other group received rituximab each time cancer showed signs of growth. Both groups continued treatment until the medicine stopped working. (Kahl BS J Clin Onc 2014). With ten years of follow-up, researchers found that rituximab alone, administered by either dosing strategy, was highly effective at controlling cancer growth. Follow this link to Abstract 815.
Multiple Myeloma – Chromosome 1 abnormalities can impact the prognosis of patients with a new diagnosis of multiple myeloma with standard risk.
- First author : Timothy M. Schmidt, MD (University of Wisconsin). While chromosome 1 abnormalities are associated with high-risk features in multiple myeloma, this research provides new information about their prognostic impact in patients with standard-risk features: gain1q, amp1q, and del1p conferred inferior progression-free survival. This is a post hoc subgroup analysis from the randomized phase 3 ENDURANCE trial (or study E1A11). ENDURANCE found no improvement in progression-free survival by replacing bortezomib with carfilzomib in the standard initial treatment of patients with newly diagnosed myeloma with either standard or intermediate-risk features. Here, the authors state that treatment with carfilzomib, lenalidomide, and dexamethasone (KRd) may overcome the negative overall survival impact among patients with +1q and del1p, but not among those with amp1q. Further, they suggest that patients with +1q and del1p should be considered to have high-risk multiple myeloma and be candidates for clinical trials that explore novel treatment strategies. They acknowledge the limitations of this research and state the need for further study. Follow this link to Abstract 467.