ASH 2018: Research That Will Make a Difference for Tomorrow's Oncologist

Dr. Chandler Park is an American physician, media correspondent, and clinical researcher. He shared his picks for top 4 takeaways from ASH 2018 with Doximity.

Doximity: What were your key takeaways from ASH this year?

Park: You know as a physician, I think it's a privilege to learn as much as we can for our patients. I was at a dinner meeting last night with Chuck Pagano, who's the Indianapolis Colts former head coach and he's a warrior that's been successful in the sports world. But as a hematologist/oncologist, he kind of let us know during the meeting last night how important [and] how much trust that our patients [instill in] us. Whether you are very successful as a football coach or whether you're being treated by a local community oncologist, it's very important that we learn as much as we can to provide the best care because our patients trust us.

Now, going along your question, I think for me there's been a lot of breakthroughs in terms of treatments. I want to kind of focus on treatments that would affect the community oncologist because there [are] so many different key trials that play a big role. However, I want to see what studies will start making changes tomorrow for our new oncologist, so these are studies that I feel will make a difference for tomorrow's clinic.

Chronic Lymphocytic Leukemia

One study, in particular, is for chronic lymphocytic leukemia. Just to kind of let the audience remember about chronic lymphocytic leukemia, it is the most common leukemia in America. It's been shown that in the past that the treatment has been for chemotherapy and then we actually had a targeted medication called Rituximab. Before this meeting, the standard of care was called chemoimmunotherapy, where you would actually treat with Rituximab and chemo, most commonly Bendamustine or Fludarabine, Cytoxan, and Rituximab.

Now, with the plenary session yesterday, they did a phase 3 clinical trial where they compared three arms: one group of patients [in a randomized, phase 3, multi-national, multi-centered study] received Ibrutinib, which is a Bruton's tyrosine kinase inhibitor. The second group received Ibrutinib with Rituxan. And the third group actually received Bendamustine Rituxan, which is considered a good comparison arm. What they found is Ibrutinib, which is a pill only, showed superior progression-free survival even compared to the Rituximab with Ibrutinib, and also superior to Bendamustine Rituxan. So the take-home message is, based upon this new study, Ibrutinib should be the new standard of care for patients that are older patients: in the study, they studied patients greater than 65 years-old. One caveat is the patients in the Ibrutinib arm actually had more atrial fibrillation, so it's gonna require us as hematologists to be more aware of the cardiac side effects and the arrhythmias and actually check out any kind of tachycardia or any kind arrhythmias.

Myeloma

The second study [that] I think is very important is in the myeloma world. Myeloma has gone through a lot of transformation. I met one of my friends, Dr. Klein from the NIH, last night and we were kind of talking about comparing myeloma to diffuse large b-cell lymphoma. We did a little historical context of looking in the past, and it was interesting: right now the standard of care for diffuse large b-cell lymphoma is R-CHOP. It started out as CVP and then we showed that CHOP was superior to CVP and then afterward we show that R-CHOP, when the Rituxan was actually FDA-approved, was superior to CHOP.

Similarly, in the myeloma world, the standard of care since the plenary session couple years ago was VRD, which is Velcade Revlimid and Dex, and that's been shown to be superior. Now with this new CD38 daratumumab that's been shown in ASH to be a candidate to be in the first line setting. Daratumumab is a CD38 monoclonal antibody, and it's shown superior results in some of the studies in the phase 1, phase 2 studies.

Tomorrow, we have a study that's going to be eagerly anticipated by all of the hematologists called the MAIA Study and it's a phase 3 clinical trial, randomized where the treatment arms are Revlimid and Dex versus Daratumumab Revlimid and Dex for patients that are transplant ineligible. This study is going to show superior PFS and superior OS—so that right there should be considered a standard of care for patients that are transplant ineligible for multiple myeloma. Now, going forward, the other thing that I've noticed is for patients who are transplant-eligible. There were some early updates on something called the GRIFFIN Trial, which is a phase 2 clinical trial, and it showed that patients that receive VRD, Velcade Revlimid and dex, and the comparison arm was Daratumumab, Velcade, and Revlimid and Dex and it showed that it did not increase toxicity and actually increased response rate. So I'm excited about that study once that matures

Myelodysplastic Syndrome

The third study that I found very interesting was also a plenary study session yesterday for our patients with myelodysplastic syndrome. Myelodysplastic syndrome is a very tough disease because underneath the microscope and the bone marrow, it's a myeloproliferative kind of a process. However, our patients end up with low red blood cells, and they require constant blood cell transfusions. So in this study, they found this new medication, luspatercept, that you actually give the patients and actually [it] showed that the patients receive less blood transfusions. Because receiving too many blood transfusions can actually increase toxicity and iron overload disease, so I thought that was very exciting. There's actually some preliminary phase 2 studies for our thalassemia patients, so that's another study I'm kind of keeping an eye on.

Lymphoma

One more study that I think is kind of interesting and that's in the lymphoma world. Just kind of mentioned earlier--our standard of care for diffuse large b-cell lymphoma was R-CHOP, and it's currently R-CHOP for a germinal center activated b-cell subtype—there might be a new standard of care in the future. However, in this study for the young, fit, 18 to 60-year-old patients with stage 1 stage 2 diffuse large b-cell lymphoma, they actually show some preliminary studies that showed four cycles of R-CHOP might be equivalent to six cycles of R-CHOP with much less toxicity, so I'm looking forward to that study to see if that would be considered the new standard of care: four cycles of R-CHOP versus six cycles. The patients that got four cycles of R-CHOP still received two more cycles of Rituxan.

It's been action-packed—a lot of great studies in this meeting

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