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Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

The latest advances in the treatment of blood cancers and blood disorders greeted attendees at the American Society of Hematology (ASH) 2017 Annual Meeting, held December 8 to 12 in Atlanta, Georgia. The meeting featured more than 4500 abstracts, including 1000 presented at oral sessions.

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

Many reported trials are expected to have an impact on clinical practice. Among the highlights:

  • Oral anticoagulant may be a viable alternative for VTE in cancer patients
  • Brentuximab vedotin poised to move to frontline in Hodgkin's lymphoma
  • Durable responses with CAR T cells in advanced lymphoma
  • Daratumumab improves outcome in newly diagnosed multiple myeloma
  • Mogamulizumab a valuable new option for cutaneous lymphoma
  • Mastocytosis becomes a 'disease you don't want to miss'
  • Blood transfusions in leukemia a deterrent to hospice care

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

Oral Edoxaban a New Alternative for VTE in Cancer Patients?

While low-molecular-weight heparin (LMWH) is the standard therapy for cancer-related venous thromboembolism (VTE), oral anticoagulant agents may be a viable alternative, suggest new findings. A large randomized study found oral edoxaban (Savaysa, Daiichi Sankyo) to be noninferior to subcutaneous injection with dalteparin (Fragmin, Pfizer) in terms of recurrent VTE or major bleeding. A primary event (defined as first recurrent VTE or major bleeding event) occurred in 67 of 522 patients (12.8%) in the edoxaban group compared with 71 of 524 patients (13.5%) in the dalteparin group (hazard ratio with edoxaban, 0.97; P = .0056 for noninferiority). "There was a lower rate of recurrent VTE observed with edoxaban, but that was offset by a similar increase in risk of major bleeding," said lead author, Gary E. Raskob, PhD, from the University of Oklahoma Health Sciences Center, Oklahoma City. "I think this is going to usher in a new standard of care," commented Robert A. Brodsky, MD, director of the Division of Hematology at Johns Hopkins School of Medicine in Baltimore, Maryland. "It is a common question that oncologists face, and a lot of patients can't inject themselves — it's not an easy thing to do."

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

First in 30 Years: Improved Front Line in Hodgkin's Lymphoma

Brentuximab vedotin (Adcetris, Seattle Genetics) has already made an impact on the management of relapsed/refractory (r/r) Hodgkin's lymphoma (HL), but now it looks poised to be used earlier in the disease course. Data from the ECHELON-1 study suggest that the drug can be integrated into the frontline management of advanced HL. Patients with stage III or IV HL who received brentuximab vedotin up front in combination with a three-drug chemotherapy regimen (AVD: doxorubicin, vinblastine, and dacarbazine) had a 23% significantly reduced risk for progression, death, or the need for additional therapy compared with those who received the standard four-drug regimen (ABVD: doxorubicin, bleomycin, vinblastine, and dacarbazine). "The study results represent the first successful effort in more than 30 years to improve outcomes of first-line treatment in patients with advanced HL without escalating the toxicity of the chemotherapy to unacceptable levels," said lead author, Joseph M. Connors, MD, from the British Columbia Cancer Agency Center for Lymphoid Cancer in Vancouver, Canada.

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

CAR T Cells in Advanced R/R Lymphoma: Keeping Patients Alive

New longer-term clinical data with chimeric antigen receptor (CAR) T cells now reported for patients with refractory and relapsed non-Hodgkin's lymphoma show that the responses are durable in about half of those treated, with the suggestion that for those patients, this therapy looks to be curative. "This is what everyone has been wanting to know — can the impressive initial responses be sustained over time? What is the durability of these responses?" commented David Maloney, MD, from Fred Hutchinson Cancer Research Center in Seattle, Washington. The new results are showing complete responses in just over half of patients (54% to 57%) and show that these are maintained in the longer term in most of these patients. He pointed to new results from a longer follow-up of the ZUMA-1 trial, presented at the meeting by Sattva Neelapu, MD, from the University of Texas MD Anderson Cancer Center, Houston, in which patients received a single infusion of axicabtagene ciloleucel (Yescarta, Kite). At a median follow-up of 15 months, 42% of patients remain in remission and 40% of patients exhibit no evidence of cancer. "This is very, very impressive. This is what the field has been waiting for, and this will serve as a benchmark for other products," said Dr Maloney.

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

Daratumumab Ready to Move to Front Line in Multiple Myeloma

The novel monoclonal antibody product daratumumab (Darzalex, Janssen) is already used for patients with multiple myeloma who have progressed on other therapies, but now it has been propelled to the front line. New results show that it also improves outcomes in patients with newly diagnosed multiple myeloma who are ineligible for transplant when used in combination with triple therapy. The findings, from the phase 3 ALCYONE trial, show that when daratumumab was added to a regimen of bortezomib (Velcade, Millennium), melphalan, and prednisone (D-VMP), there was a 50% lower risk for disease progression or death compared with triple therapy without the antibody. "In this first phase 3 randomized study with a monoclonal antibody in newly diagnosed multiple myeloma, D-VMP also induced significantly deeper responses, including a more than threefold higher minimal residual disease negative rate," said study author Jesus F. San-Miguel, MD, from the Clínica Universidad de Navarra-CIMA, IDISNA, Pamplona, Spain. "There were also no new safety signals except for higher infection events that resolved," he said.

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

Mogamulizumab: Valuable New Option for Cutaneous Lymphoma

The investigational agent mogamulizumab (Kyowa Kirin) holds promise as a new treatment option for cutaneous T-cell lymphoma (CTCL), according to results of the phase 3 MAVORIC trial. Mogamulizumab is a humanized monoclonal antibody directed against CC chemokine receptor 4, which is frequently expressed on leukemic cells of certain hematologic malignancies, including CTCL. In the study, mogamulizumab achieved a median progression-free survival (PFS) of 7.7 months, which is significantly longer than the 3.1 months for those treated with vorinostat (Zolinza, Merck & Co). "This is the first report of a randomized phase 3 study evaluating PFS as a primary endpoint in CTCL to compare a new systemic therapy against an FDA [US Food and Drug Administration]-approved agent, utilizing the consensus comprehensive global response criteria," said lead author, Youn H. Kim, MD, from Stanford University School of Medicine in California. "Mogamulizumab demonstrated significantly superior efficacy outcomes compared to vorinostat in patients with previously treated CTCL. This study supports mogamulizumab as a valuable new therapeutic option in patients with CTCL," said Dr Kim.

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

Mastocytosis Becomes a "Disease You Don't Want to Miss"

Most hematologists and oncologists will not have come across systemic mastocytosis, but a new targeted drug that homes in on the underlying defect will help put this disease on physicians' radar, says one expert. From the clinician's point of view, "once there's an effective therapy, this is a disease you don't want to miss," said Daniel DeAngelo, MD, PhD, from Dana-Farber Cancer Institute, Boston, Massachusetts. Dr DeAngelo presented clinical data with a novel agent, avapritinib (BLU-285, Blueprint Medicines), which targets a specific mutation found in 90% of cases of mastocytosis. The results, from an early dose-escalation trial, show impressive activity, with disease control seen in all patients, and improvements in clinical symptoms seen quickly. "The rapidity of the improvement is extremely dramatic," he said. There are an estimated 2000 mastocytosis cases per year in the United States, which is about half that for chronic myeloid leukemia. Dr DeAngelo thinks this is an underestimate because the disease is often unrecognized and is certainly underdiagnosed. He said that when he first became interested in this condition, "almost as a hobby," he was seeing one or two patients a year. Now he sees one or two patients a week.

Image from iStock

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

Blood Transfusions in Leukemia a Deterrent to Hospice Care

Patients with late-stage blood cancers use hospice less often than patients with solid tumors, and once they do get to hospice, their stay is much shorter, a new study shows. One barrier to hospice use in this population is the need for blood transfusion. Patients with leukemia who were transfusion dependent had a hospice stay that was about half as short as that in patients with leukemia who were not receiving blood transfusions. Those receiving transfusions had a 38% higher risk for receiving hospice care for less than 3 days, reported Thomas Leblanc, MD, from Duke Cancer Institute, Durham, North Carolina. "Although more leukemia patients are using hospice, they're not doing it in a meaningful way," said Dr Leblanc. "The stay was very short, under 2 weeks, and you don't get very much benefit from those services when you only use them for hours or days." The study also shows that patients with leukemia who do use hospice services do dramatically better on end-of-life quality measures, including emergency department use. "This also translated to a cost reduction of about $10,000 per Medicare beneficiary for leukemia patients who utilized hospice care," he noted.

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

Ibrutinib and Venetoclax: Potential Combination for r/r CLL

Two of the newest drugs for the treatment of chronic lymphocytic lymphoma (CLL) have been added together, and the combination is "particularly impressive" in eradicating minimal residual disease (MRD), or MRD negativity, in patients with relapsed or refractory CLL (r/r CLL). At least a third of the patients achieved MRD with the two drugs taken together for 6 months. The two drugs are ibrutinib (Imbruvica, Pharmacyclics and Jannsen) and venetoclax (Venclexta, AbbVie/Genentech/Roche). They act as inhibitors of two separate pathways implicated in the pathogenesis of CLL. The results for the combination come from the Bloodwise TAP CLARITY study. "MRD is the deepest level of response that can be achieved with no detectable disease in the bone marrow," said lead study author, Peter Hillmen, MBChB, PhD, from Leeds Institute of Cancer and Pathology in the United Kingdom. "These initial results are particularly impressive in a patient population for whom previous therapies have failed," said Dr Hillmen. "We have shown that the two drugs can be given in combination without obvious additional toxicity, and the inability to detect disease with the most sensitive tools we have is a very good sign that the combination is proving to be an effective treatment," he added.

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

Venetoclax and Rituximab: New Standard of Care in CLL?

The standard of care for (r/r CLL looks set to change to a combination that does not contain chemotherapy. The current standard of care is chemoimmunotherapy with bendamustine (Treanda, Teva Oncology) and rituximab (Rituxan, Genentech) (BR), but new results from the MURANO trial show superior results with a new combination of the novel targeted agent venetoclax (Venclexta) with rituximab (VR). The new data, from a first interim, preplanned analysis of the trial show, that VR was associated with an 83% reduced risk for disease progression compared with BR. The superior benefits were observed across all clinical trial endpoints. The study suggests that venetoclax "should replace chemotherapy for relapsed/refractory CLL and is suggestive that the combination with rituximab is the preferred manner to use the drug. There is also evidence of eradication of detectable disease that opens the prospect of time-limited therapy in this setting," said lead author, John Seymour, MBBS, PhD, from Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Australia.

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

Emicizumab "Life-Changing" for Hemophilia A With Inhibitors

Emicizumab (Hemlibra, Roche), recently approved to prevent or reduce the frequency of bleeding episodes in children and adults with hemophilia A with factor VIII inhibitors, has been hailed by experts as a "game changer." Now details from an updated analysis from HAVEN 2, the largest phase 3 study reported in children with hemophilia A with inhibitors to factor VIII, show that the drug was effective in substantially reducing bleeding episodes and was well tolerated. "Weekly subcutaneous emicizumab may provide a new standard of care for hemophilia management by providing an effective, safe, and convenient option for pediatric patients with hemophilia A," said lead investigator, Guy Young, MD, from Children's Hospital Los Angeles and the University of Southern California. He also described the effect the drug is having on the lives of these young patients. "Before this drug, we didn't have very effective ways to prevent joint bleeding in these patients," he commented. "This drug has demonstrated a very high level of efficacy at preventing those bleeding events. It's been life-changing for the children I've treated."

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

"Promise of a Cure": Gene Therapy for Hemophilia A

Patients with hemophilia A who received a single infusion of an investigational gene therapy called valoctocogene roxaparvovec showed substantially increased levels of the essential blood clotting factor VIII. Eleven of 13 patients who took part in the study achieved normal or near-normal factor VIII levels. Self-reported bleeding and external use of factor VIII were profoundly reduced in cohorts of participants given a high dose of valoctocogene roxaparvovec. The new data were reported and simultaneously published in the New England Journal of Medicine. "Hemophilia A is a single gene disorder with a clear cause-and-effect relationship and, with a wide therapeutic window, is an ideal candidate for gene therapy," said lead researcher, K. John Pasi, MD, from Barts and the London School of Medicine and Dentistry and Barts Health NHS Trust, United Kingdom. "The clinical data to date for this investigational gene therapy exceeded our expectations, in terms of increasing factor VIII levels and reducing the annualized bleed rate," he added.

Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

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Top News From ASH 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Lynsey Weatherspoon; Megan Brooks | December 22, 2017 | Contributor Information

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