For now, a quick look at one of the hot topics of the ASCO conference: CAR-T. There were dozens of presentations about various CAR-T treatments. Not all were about Follicular Lymphoma. But it's clear that CAR-T treatments are one of those approaches that oncologists are excited about, and are putting a lot of hope into.
(And looking back at what I write about day 1 and day 2 of the conference, it seems like most cancer folks are going with the "we should be excited!" approach to CAR-T form day 1, rather than the "we need to learn a lot more!" approach of day 2, which is interesting.)
So here's a quick run down of some more of the CAR-T stuff that came out of the ASCO conference (and this is just some, not all, by any means):
- One of the ways around the high expense of CAR-T is by developing an "off the shelf" version. In other words, instead of a treatment that is made for each individual patient, there could be a version that works for everyone who wants it. Results of a phase 1 study trying to do that: "First-in-human data of ALLO-501 and ALLO-647 in relapsed/refractory large B-cell or follicular lymphoma (R/R LBCL/FL): ALPHA study." In a very small study of DLBCL and aggressive FL patients, patients were first given a treatment to wipe out most of their existing T cells. Then they were give the "off the shelf" CAR-T. Like personalized CAR-T, this one targets lymphoma cells. But the pre-treatment makes sure that the patient's immune system doesn't get in the way of the new T cells as they go after cancer cells. The treatment was effective (9 patients were evaluated, with 3 Complete Responses and 4 Partial Responses, for a 78% response rate). As a phase 1 trial, safety is a primary concern, and it was shown to be safe, with expected side effects. 9 patients is very, very small, but the results are enough to continue on a larger group. Definitely worth watching.
- Most CAR-T treatments involve targeting of the CD19 protein on the cancer cells. Those kinds of targets are common -- Rituxan goes after the CD20 protein. While targeting CD19 seems effective, some researchers think it contributes to CAR-T being able to work well at first, but then stop working. One presentation, "Safety and efficacy of optimized tandem CD19/CD20 CAR-engineered T cells in patients with relapsed/refractory non-Hodgkin lymphoma," described a CAR-T treatment that targets both CD19 and CD20. Two targets might be better than one. The study described a combined phase 1/phase 2 trial with 99 patients with several different lymphomas, incuding some with FL and transformed FL. Overall, the early results look good, with 84% getting a response after a follow-up of 13.5 months, and the treatment being fairly safe. If the goal, though, is to produce longer responses than CAR-T with only one target, then longer-term follow up is going to be really important. Another one to keep an eye on.
- On the other hand, there was one study of long-term follow-up of CAR-T patients, called "Long-term follow-up of anti-CD19 CAR T-cell therapy for B-cell lymphoma and chronic lymphocytic leukemia." The study describes a group of patients who were given early versions of CAR-T treatment at the National Institute of Health between 2009 and 2015 -- 43 patients in all. They had a variety of lymphomas, including 5 with FL. The overall remission rate was 76%, with 54% complete remission and 22% partial. Long-term side-effects were minimal. Of the patients who had a CR, 15 of the 25 were still in remission. While the long-term effects for some patients were excellent (the FL patients did especially well), they were still limited -- close to the breakdown I have heard (1/3 of patients have a long remission, 1/3 have a shorter remission, and 1/3 have no remission). But these are also patients who had an early version of CAR-T, and the treatment does seem to be improving as researchers learn more from patients who have had some version of it.
2 comments:
Thanks Bob for all the information. I honestly dont know what I would do without your blog. So grateful to you.
My pleasure, Paula. Thanks for reading.
Bob
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