ASH: The Leonard List

For today's look at what's happening at the ASH conference, I want to highlight the 2020 Leonard List.

John Leonard is a blood cancer researchers and certified Lymphoma Rock Star from Weill Cornell Medicine in New York City. Each year, a couple of weeks before ASH, he publishes The Leonard List, the 10 presentations at ASH that he finds more interesting or significant. He posts one a day on Twitter, and discusses them on CancerCast, the Weill Cornell podcast devoted to cancer.

This year's Leonard List podcast (along with the other CancerCast episodes) is available here. 

Sometimes Follicular Lymphoma makes a lot of appearances on The List. Not so much this year, at least not any new researcher that might really change things for all of us. (That's kind of rare, anyway.) The podcast includes his top 10 list, plus an additional 5 presentations. This year, he includes one Follicular Lymphoma presentation in his top 10, plus one in his 5 bonuses, plus another one that is more general, but interesting anyway.

#5 on The Leonard List is called "Racial and Ethnic Disparities in the Survival of Patients with Indolent Non-Hodgkin Lymphoma in the United States: A Population-Based Analysis."This study looked at the SEER (Surveillance, Epidemiology, and End Results) database of cancer patients to determine if there are differences in outcomes among patients with slow-growing blood cancers of different races. They looked at the records of over 63,000 patients (35,466 had Follicular Lymphoma) and found that, unfortunately, there were differences. Over the last 20 years, racial minorities, overall, had lower survival. Native Americans and Alaska Natives had the highest mortality, followed by Non-Hispanic Black patients, Asians/Pacific Islanders, and Hispanics.The study doesn't look into why this is the case, but the researchers think that access to health care might be a big part of the reason. they hope their research will encourage other researchers to find out more about why these differences exist. I think it's a good time for this research, and I think even it might not seem like all of us are affected by this research, we all benefit from any study that shows how to make access to healthcare an easier thing. We all have a right to it.

One of the "bonus" studies on the Leonard List is called "Minimal Residual Disease Monitoring from Liquid Biopsy By Next Generation Sequencing in Follicular Lymphoma Patients." In this study from Spain, researchers looked at Minimal Residual Disease (MRD) in FL patients by measuring it with PET scans and "liquid biopsies." MRD is the tiny amounts of cancer that exist after treatment, maybe so small that they don't show up on a scan. But even a tiny amount can grow without anyone noticing, and by the time it is detectable, it may have become aggressive. By figuring out a way to find those tiny bits of cancer right after treatment, a consolidation therapy can be used (maybe something like R-maintenance) to clean up those little bits. The researchers in this study identified some biomarkers -- mutations that signaled that there were still little bits of cancer hanging around -- that got left behind, and then figured out how to detect them through a blood test. This research is still in its early stages, but it does seem promising. And it's important -- patients with MRD after treatment have worse outcomes than those who don't have MRD.

Finally, #7 on The Leonard List is not about Follicular Lymphoma in particular, but I think it's an important study. It's called  "Phase I Studies in Hematologic Malignancy: 20-Year Experience from Cancer Therapy Evaluation Program (CTEP) at National Cancer Institute/National Institutes of Health." The study looks at data from all of the phase 1 clinical trials for blood cancer treatments from the last 20 years, which involved about 3300 patients (about 920 with different kinds of lymphoma). As you may know, new treatments have to go through 3 phases of clinical trials before they can be approved. Phase 1 trials involve a small number of patients, and assess the safety of a new treatments (how sever any side effects might be), as well as how effective the treatment is (how many patients respond to it). Phase 2 and 3 involve larger groups of patients, and focus more on effectiveness, while also making sure the treatment is safe. Because phase 1 participants are the first to try a new treatment, it can be a little risky to be involved. Very often (but not always), phase 1 participants are patients who are running out of options. What's so great about this study is that it reaffirms that phase 1 trials are not only for the "desperate" patients. In the last 20 years, more trials involve targeted treatments, rather than traditional chemotherapy, and they are fairly effective: Overall, about 21% of blood cancer patients in phase 1 trials have a response to the treatment, and for lymphoma patients, it;s even better (40% response). That number has gone up over time. But at the same time, safety has remained about the same -- the side effects have not gotten worse. It suggests that targeted treatments might be even more effective by the time they get to phase 1. All of this suggests that patients should be encouraged to participate in early trials.

Which makes this an excellent time for an important reminder -- all of the great new treatments being discussed at ASH can only be great if there are patients who are willing to try them out. If you have a chance to participate in a clinical trial, please consider it. When I meet with my oncologist, I make it a point to ask about new treatments, and as we talk, I ask if any are in trials at the hospital I go to -- trials that might be appropriate for me. Personally, I like to now the options that are available, even before I might need them. And that includes treatments that are in trials.

More ASH news to come.