ASH 2014: If You're Going to San Francisco...

Bruce D. Cheson, MD


November 25, 2014

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For those of you who are thinking of going to the American Society of Hematology (ASH) meeting, this is Bruce Cheson for Medscape Hematology, giving you a preview of what will be happening in San Francisco.

There will be gentle people. Some will have flowers in their hair—hopefully not at the meeting, however. People will be coming from all across the nation. There will be a strange vibration, although hopefully not an earthquake, but there will be people in motion all over the conference center. People in motion—a whole new generation of young investigators, new drugs, and new explanations for what is going on in cancer medicine. Going to San Francisco would be a good idea, because the ASH meetings this year are destined to be quite excellent.

With respect to chronic lymphocytic leukemia (CLL), there will be some follow-up and some new data. The CLL-10 trial will be updated.[1] That is the head-to-head comparison of rituximab/bendamustine and fludarabine, cyclophosphamide, and rituximab (FCR). In older patients, bendamustine was clearly the superior regimen.[2] The question was whether this would hold true in younger patients, and those data on younger, fit patients will be presented at this meeting.

The most difficult group of patients has traditionally been those with 17P deletion. There will be some exciting data on the use of ibrutinib,[3] as well as idelalisib and rituximab in this patient population.[4] We will hear data on the combination of ABT-199, the Bcl-2 inhibitor, plus rituximab[5] and some new drugs, such as dinaciclib, which is a cyclin-dependent kinase (CDK) inhibitor.[6]

With respect to the indolent lymphomas, we will hear the results from the phase 2 trial of single-agent ibrutinib.[7] We will also see some data with duvelisib (IPI-145), the PI3K delta gamma inhibitor,[8] and in T-cell lymphomas.[9]

The so-called "R-squared regimen," rituximab and lenalidomide ( Revlimid®), has become very popular. There are some very good data from the CALGB [Cancer and Leukemia Group B; now the Alliance for Clinical Trials in Oncology] and from MD Anderson on the use of this combination in frontline follicular lymphoma,[10] and this has led to an international RELEVANCE trial[11] comparing R-squared vs R-chemotherapy. This trial has been completed. It will not be presented at this meeting but hopefully will be in the future. In the meantime, some very interesting data on the use of this regimen in relapsed and refractory indolent lymphoma in front line will be presented. There are also some very impressive data from the Cornell group on the use of R-squared in front-line mantle cell lymphoma.[12] There will be some data with lenalidomide single-agent vs standard therapy in relapsed, refractory mantle cell lymphoma[13] and in large cell lymphoma.[14]

The topic of interim PET scans in large cell lymphoma is quite controversial. What do you do with the information? If it is positive we know what to do. If it is negative, most patients—although not all—will do quite well. If it is positive, what happens if you change treatment based on that information? Two studies will be presented, one from the British Columbia Cancer Agency[15] and one from the PETAL trial,[16] which will show what happens in patients whose therapy has been altered on the basis of a PET scan.

Brentuximab vedotin is the anti-CD30 antibody drug conjugate that has exquisite activity in Hodgkin lymphoma and anaplastic large cell lymphoma. About one fourth of patients with large cell lymphoma are positive for CD30, and the drug seems to have activity in those patients, but we will also see data at these meetings from patients in whom CD30 is undetectable.[17] We will also see a study[18] designed to determine whether we can predict patients with large cell lymphoma who are most likely to have central nervous system (CNS) relapse. In the past, based on German data and other studies, it has been quite clear that it is difficult to predict those patients, and even if we try to use prophylactic CNS therapy, it is not always successful. This multigroup international study is trying to develop a prognostic index with which we can better predict those patients, intervene, and hopefully improve their outcomes. We will see the results of that study.

In Hodgkin lymphoma, we will see the update of the Italian study[19] comparing bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). In the earlier analysis, there was no advantage to BEACOPP, so we will see what happens with additional follow-up.[20] There will be data on the combinations of brentuximab vedotin with bendamustine.[21] We will see the update of the A2VD regimen (doxorubicin, vinblastine, and dacarbazine).[22] We will see some data using brentuximab as first-line salvage therapy prior to stem cell transplant in patients with relapsed, refractory disease.[23]

It seems like it is going to be a good meeting, both for follow-up and for novel approaches, so I hope to see you in San Francisco. Whether you have flowers in your hair is up to you, as long as you show up at the meeting. This is Bruce Cheson, signing off for Medscape Hematology.


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