ASCO: Bispecific + R-Squared

Before I get to more ASCO news, a quick announcement: I was nominated again this year for a WEGO Health Award.

Except there have been a lot of changes to the awards this year, starting with the name: It's now known as the Social Health Awards. Also, all of the categories have changed. So while there's no more "Best of Show: Blog" award, there is one called Revolutionary Researcher, which will be given to an advocate who "stays up-to-date on the latest research, treatments, and clinical trials. This patient leader has a knack for transforming complex information into layman terms for the greater community to act on." I'll be honest -- I'm kind of excited about this one. This kind of advocacy doesn't always get much recognition. 

The final big change this year is that the timing for the "endorsement" period (where people can vote for their favorites) is much shorter -- only a few days (June 27  to July 1). I'll put up a link when you're allowed to give endorsements next week, if you are interested in voting.

Now, on to more ASCO.

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The ASCO presentations I've been looking at so far have been a little bit broader, in a way, than I was expecting -- more about bigger lessons than about specific treatments (though there are always big lessons to learn from ASCO).

So here's one about straight up research: "Subcutaneous epcoritamab with rituximab + lenalidomide (R²) in patients (pts) with relapsed or refractory (R/R) follicular lymphoma (FL): Update from phase 1/2 trial."

The treatment discussed here is called a "triplet" -- three different treatments given together. In this case, the treatments are Epcoritamab, a bi-specific, and Rituxan + Revlimid (also known as R-squared).

On the surface, this is kind of a powerhouse combination. B-specifics are creating a lot of excitement in the lymphoma community, and are seen as a potentially less expensive option to CAR-T. And R-squared is being used as an alternative to traditional chemotherapy -- just as effective, with a different set of side effects. So putting them together seems like an excellent idea.

And the results discussed in this presentation back that idea up. It's an update to the phase 1 and phase 2 results of a clinical trial. Early results showed a 90% Response to the triplet, with 50% getting a Complete Response. In the update, which looked at 30 patients with relapsed or refractory Follicular Lymphoma, (a fairly small number, but typical for a phase 1/2 trial), 28 patients remained on the treatment after a median of 5 months (two left the trial because their disease progressed). And all 28 of those remaining continued to respond to the treatment. And 40% of the patients in the trial were POD24, a very high-risk group. But they also had lasting responses, which is great news.

5 months isn't a very long time (the longest in the trial was 12 months), so there will need to be more on long-term durability reported in the future. But the initial response is impressive.  That's the advantage of a well-constructed triplet --  you can come at the cancer cells from several different ways. 

Of course, the potential disadvantage of a triplet is that you have the possibility of 3 times the side effects. In this case, the bi-specific and the R-squared generally don't have overlapping side effects (according to the researchers). But that means potential for more side effects, just not as severe as they might be. These included infections (in 57% of the patients in the trial), injection-site reactions (50%), constipation (37%), fatigue (37%), and nerve issues (37%). Cytokine Release Syndrome was an issue for 50% (mostly grade 1 and 2), and all were taken care of within 4 days, except for one patient who had to discontinue the study.

So overall, this seems like an effective treatment combination with manageable side effects. 

It will be very interesting to see how well they do in future updates (maybe we'll see one at ASH in December?) and if the results justify a larger, stage 3 clinical trial. 

I've said before, it seems to me that combinations like this will likely be a part of our treatment futures. It's good to see that some treatments that do well on their own can work effectively together as well.

More ASCO soon.