ASH News Daily - Sunday, December 11, 2011 - (Page A-2)

Page A–2 ® ASH News Daily 2011 Editorial Board Editor Joseph Mikhael, MD, MEd Mayo Clinic Arizona Authors Michael R. Bishop, MD Medical College of Wisconsin Amanda M. Brandow, DO, MS Medical College of Wisconsin David Garcia, MD University of New Mexico Cancer Center Shari A. Ghanny, MD McMaster University Heather Landau, MD Memorial Sloan-Kettering Cancer Center Julie A. Panepinto, MD, MSPH Medical College of Wisconsin Barbara Pro, MD Fox Chase Cancer Center ASH NEWS DAILY HODGKIN LYMPHOMA How Little is Too Much and How Much is Too Little in Hodgkin Lymphoma? By BaRBaRa PRo, Md W hat a journey it has been for Hodgkin lymphoma since the first report by Thomas Hodgkin, “On Some Morbid Appearances of the Absorbent Glands and Spleen,” in 1832. The histological origin of the neoplastic cells was a mystery for years, until analysis of immunoglobulin genes revealed that these cells were abnormal but clonal B cells. Hence, the disease described by Hodgkin became a true lymphoma and has been renamed as such. In parallel, with a better understanding of the biology of the disease, significant progress has been achieved in the combination treatment that has translated into a dramatic increase in cure rate. So, the major dilemma of this modern time is how little is too much for patients who will survive Hodgkin lymphoma (HL), and how much is too little for those patients who will not do well. Dr. Ranjana Advani, Stanford University, chairs the Education Program session on Hodgkin Lymphoma outlining recent advances in the treatment of the disease. This session will be repeated this morning at 9:30 a.m. in Room 20AB, of the Choices «« From Page A-1 Michael A. Rosenzweig, MD City of Hope The information contained in ASH News Daily is provided solely for educational purposes. A diversity of opinions exists in the field of hematology, and the articles in this publication are often intended to inform readers about more than one point of view. These articles are not comprehensive and should not be used as a substitute for traditional sources of hematology information, traditional diagnostic and treatment information, or the individual judgment of health-care providers. The views expressed in ASH News Daily do not necessarily represent ASH’s views, and their inclusion in this publication should not be interpreted as an endorsement by ASH. ASH is not responsible for any inaccurate or inappropriate use of the information, publications, products, or services discussed or advertised within. ©2011 by the American Society of Hematology All materials contained in this newspaper are protected by copyright laws and may not be used, reproduced, or otherwise exploited in any manner without the express prior permission of ASH News Daily. Contributing authors have declared any financial interest in a product or in potentially competing products, regardless of the dollar amount. Any such financial interest is noted with the author byline. Kettering Cancer Center, discussed the current role for autologous SCT in multiple myeloma and acknowledged that the benefits of transplant were demonstrated prior to the availability of regimens containing novel therapies. He reviewed the studies that have the potential to change treatment standards in the future, and highlighted the need to consider the burden of therapy when evaluating all approaches. While Dr. Giralt remains a believer in the value of SCT, he acknowledges the need for more data with respect to both autologous and allogeneic SCT. While he admitted his enthusiasm for reduced-intensity allogeneic SCT in myeloma has waned based on the results of the BMT-CTN 0102 trial, novel approaches including T cell depleted myeloablative allogeneic SCT still hold promise, and preliminary results of this approach were presented later in the day by Dr. Guenther Koehne (abstract #1992). Certainly, there is a subset of patients with short remissions in need of aggressive therapy. In the last part of the session, Dr. Kenneth C. Anderson, Dana-Farber San Diego Convention Center. Dr. Advani will open the session with a review of the current clinical management of patients with advanced HL. With current treatments, advanced- s tage HL is curable in 65 to 89 percent of cases and the five-year survival rate is 90 percent. “Challenges are how to individualize treatment choices and what is the optimal chemotherapy,” Dr. Advani said. While the combination of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) has been considered the “gold-standard” treatment for advanced HL, 20 to 30 percent of patients fail to achieve durable remissions. Recent studies that have shown the superiority of more aggressive chemotherapy regimens such as BEACOPP escalated. However, these results are achieved at a cost of increased early and late toxicity. Moreover, there is a risk of over-treating patients who Sunday, December 11, 2011 Dr. Joseph M. Connors presents his findings during the Education session on Hodgkin Lymphoma. otherwise would have responded to a less intensive chemotherapy regimen.“Are there adequate data showing that BEACOPP escalated is better than ABVD to justify toxicity?” Dr. Advani asked. “When we look at the data of trials of ABVD we need to look at the modern ABVD, as the most current results look better. Progression-free survival is better with BEACOPP escalated across all prognostics sub-group, but a benefit in overall survival is challenging to establish,” she added. This has »» HODGKIN Page A-19 Cancer Institute, showed that there may be even more than 31 flavors when it comes to targeting pathologic plasma cells and their niches. He began the session with immunebased strategies and showed the success of elotuzumab, the humanized monoclonal antibody directed against CS1 in combination with lenalidomide and dexamethasone, which will be presented by Dr. Sagar Lonial in Monday’s Oral session (abstract #303) and is currently being studied in the phase III setting. He went on to describe two innovative vaccine approaches, one using the combination of a dendritic cell fused to a myeloma cell with the latter serving as the antigen and another utilizing a series of myelomaspecific antigens (XBP1,CD138, and CS1) in an HLA-A2 specific manner, which is a true attempt to personalize myeloma therapy. The importance of targeting both multiple myeloma cells directly and the bone marrow microenvironment was stressed throughout his presentation, which may be responsible for the success of the first-generation proteasome inhibitor bortezomib and the second-generation immunomodulatory drug lenalidomide, which are two of the better-known “novel” medicines. Other agents to look out for include the AKT inhibitor perifosine and the more selective HDAC 6 inhibitor ACY-1215, as well as mTOR inhibitors. He highlighted the multiple genomic strategies that are available to assess individual tumors and showed how multiple levels of analysis can be used over time, which will be further discussed by Dr. Nikhil C. Munshi in an oral session on Monday (abstract #297). He ended with encouraging words: “Through personalized treatment and novel approaches, multiple myeloma will become a chronic disease,” and he dared to say “cured.” So physicians and patients may be left dizzied but inspired with many options for upfront, consolidation, maintenance, and salvage therapies that were not available even just a few years ago. Yet, until science informs rational combinations and sequences of agents, we may continue to agonize over chocolate chip, cookie dough, or even cookies and cream! Dr. Rosenzweig indicated no relevant conflicts of interest. Dr. Landau served on the advisory board and receives research support from Millennium.

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ASH News Daily - Sunday, December 11, 2011

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