ASH: Natural Killers and Follicular Lymphoma

One more from ASH.

But first, Targeted Oncology wrote up a recap of ASH a couple of days ago, and described the presentations that they thought were most significant.  They list a few under Lymphoma, and the ones that focus on Follicular Lymphoma are those that focus on CAR-T (the ZUMA-5 trial) and on Bispecifics (there are a few of them). I mention this because those are the the ones that I saw the most buzz about online during and after ASH. So it's nice to see that the things I heard are also the things other people heard. I like being right. (And it should probably be comforting to you to know I get things right.)

Now, back to the last "buzzy" presentation at ASH that looked at Follicular Lymphoma:

 "Results of a Phase 1 Trial of Gda-201, Nicotinamide-Expanded Allogeneic Natural Killer (NK) Cells in Patients with Refractory Non-Hodgkin Lymphoma (NHL) and Multiple Myeloma."

GDA-201 is a treatment that involves Natural Killer Cells. These are a type of immune cell found in our bodies. Unlike some other immune cells that attack an invader (like a bacteria or virus), Natural Killer Cells attack our own cells that have been infected with an invader. Viruses, for example, work by taking over a cell and then multiplying rapidly. A Natural Killer Cell recognizes that this infected cell is different from other normal, and kills it off.  

This makes a Natural Killer Cell a really interesting target for Immunotherapy. Our own immune systems don't kill off cancer cells because cancer cells are not "invaders" or outsiders. Instead, cancer cells are our own cells that haven't learned how to die the way they are supposed to. Most of our immune cells will look at our own cells and leave them alone. But a Natural Killer Cell is made to say, "Hmm, something's not right here." But even a Natural Killer Cell won't kill off a cancer cell. Still not different enough from regular cells to be concerned.

GDA-201 gets around that by using someone else's Natural Killer Cells. The donor cells are trained to recognize cancer cells (the way the NK cell would recognize a cell that had been taken over by a virus), and goes after them. GDA-201 isn't the only attempt out there to use Natural Killer Cells, but it's the one that, so far, has shown some success with blood cancer.

For this research, donor NK cells were manipulated and grown in a lab. The cancer patients in the study were then given a monoclonal antibody (like Rituxan) to kill off or weaken a lot of the cancer cells. Then the NK cells were put into the patient.

Results were very good. It's a phase 1 trial, so there weren't many patients -- 15 with lymphoma and 15 with multiple myeloma (another blood cancer). Of the lymphoma patients, 6 had Follicular Lymphoma.

The good news is, all 6 FL patients had a Complete Response. For the whole Lymphoma group, the median duration of response was almost 9 months.  One-year estimates of Progression-Free Survival was 66%, and Overall Survival was 82%. 

Side effects were manageable. There was some concern that something like Cytokine Release Syndrome, which is common in CAR-T and some other immunotherapies, might be an issue. But at least at the doses that they tested, there were not any unexpected side effects (though there were some, of course).

This is a phase 1 trial, with very few participants, so there's certainly no guarantee that those good results for FL patients will remain in later trials. But it does seem like the makers of GDA-201 are planning to move ahead, and we'll likely see more of this treatment in the future. I kind of have a good feeling about this. (And hey, I was right about the other stuff, wasn't I?) 

But seriously, the concept does make sense, and I do think we'll hear more about this one n the next few years.

So no big blockbusters at ASH this year, but a few small things that are worth being excited about. At this point, we know that even small progress is still good progress.