Minoo Battiwalla, M.D., M.S., Director of Outcomes Research for the Sarah Cannon Blood Cancer Network, shares the latest developments in the research and treatment of blood cancer.
Developments with immune effector cells
One of the latest advancements in the field of blood cancer research is the development with immune effector cells, such as CAR T-Cells. The developments with these therapies have been recognized within the blood cancer field as significant achievements, and the promise continues to deliver. The big news is that we not only have a few products on the market that are commercially available, but also we’re now in the later phases of expanding access to these lifesaving treatments to different age groups and different subtypes.
The first groups of products targeted CD19, which is a surface molecule found across most lymphoid malignancies. Today, subsequent products have shown promise targeting other surface molecules with results in myeloma and a number of newer therapies directed against other hematologic malignancies. This includes CAR T-Cells as well as different technologies to re-direct established immune cells.
There are a growing number of clinical trials targeting different blood cancers, many of which are offered across the Sarah Cannon network.
Exploring targets outside of hematologic malignancies
Another developing theme is the exploration of targets outside of hematologic malignancies in the solid tumor setting. Because these are cellular therapies, even if the patient has a solid tumor, such as lung cancer, the treatments are best delivered by experts in hematologic malignancies and cellular therapies.
Managing unique toxicities
There’s a growing understanding of how to manage the very unique toxicities associated with the hyper inflammation that accompanies the delivery of these treatments. Broadly, there are two types of toxicities: One is the cytokine release syndrome, which is the release of inflammatory molecules when the immune effector cell encounters its target. This can cause a syndrome ranging from high fevers to leakage of the capillaries as well as cardiac and respiratory issues. The other category of side effects features neurological dysfunction typically manifesting as confusion and disorientation. With prompt recognition at specialized centers, we can deal with these complications expeditiously without long-term consequence to the patient.
The growing impact of molecular diagnostics
What was only 10 years ago thought to be an impossibly difficult task in understanding the precise genetic mutational landscape for any given hematologic malignancy has now been made simplified by rapidly available molecular diagnostic testing.
For example, in acute myeloid leukemia (AML), we know there are about 200 recurrently mutated genes, and a targeted 55 gene myeloid mutation panel can find an abnormality in the vast majority of acute myeloid leukemias and other myeloid malignancies. This has proven invaluable characterizing the underlying malignant process. Mutational analysis already offers guidance towards selection of targeted therapies and is poised to revolutionize how we deal with these malignancies in the future.
For reference, it used to take a graduate student his or her entire PhD to sequence a part of the promoter region of a gene. Today, in the space of a couple of weeks, we get detailed sequencing information on scores of genes at a time along with the full analytics required to assess whether or not the abnormality seen is an individual variation or a disease-causing mutation.
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