Transcript:
Ruben A. Mesa, MD, FACP: There is a focus and excitement about immunotherapy to a degree that there hasn’t been in the past. And undoubtedly in strong tumors, it has actually truly been incredibly impactful in several diseases. Exactly what do you think, Elias, in terms of immunotherapy, cellular-based therapies, Auto T-cells, PD-1 inhibitors, where do they stand particularly in this subset of myeloid diseases love AML?
Elias Jabbour, MD: You know, we’re shifting our means of treatment from killing the cancer cell to harnessing the immune system that can easily go after the cancer cells. And the proof of evidence we have, for example, is in checkpoint inhibitors, where we already know the cancer cell can easily suppress the immune system from exerting its role. The checkpoint inhibitors, PD-1 inhibitors, PD-L1, CTLA4 in melanoma, for example. In leukemia, we already know in MDS, there’s overexpression of PD-1; and, therefore, attempting to inhibit the suppression of the immune system can easily upregulate the T-cell function and kill the leukemic cells. It’s still also early.
People are calling us for immuno-oncology. It’s, like, fashionable now. Every person wishes to usage immune therapy everywhere. It doesn’t job everywhere. We have actually multiple trials at MD Anderson in MDS patients who: fall short on azacitidine or decitabine to be salvaged; or, up front, in combination in leukemia, unfit patients using nivolumab plus azacitidine; and also in patients that are young, to include nivolumab, which is a PD-1 inhibitor, to the standard backbone of chemotherapy.
I’m rather cautious ideal now. I don’t have actually outcomes to support it. We have actually the trials ongoing. Let’s wait until next year. The excitement is great, yet I don’t believe we have actually sufficient data to say immune therapy is prepared for AML. The Auto T-cells are still at the early stage. In ALL, it functions at the higher fee of safety concerns. The concern in AML is targeting the stem cell—going in to aplasia that will certainly never ever end—plus cytokine syndrome. So it’s still behind compared to ALL, even though the University of Pennsylvania group are functioning on engineering the Auto T-cell for myeloid disorders.
Ruben A. Mesa, MD, FACP: I believe you raised earlier this question of maintenance, and I believe that they deserve exploration across the board. yet as soon as I consider the intensity of AML, do immune-based responses truly fall ideal in to spots where we have actually time? Where they’ve been cytoreduced? There’s a patient that approached me that had located this paper saying that avocadoes had an anti-leukemic effect and he had 50% blasts, and would certainly that work? And I’m like, not all of the guacamole worldwide is going to position you in a CR along with your acute leukemia. yet if you had a low-intensity immune means to approach that group that have actually that higher risk, that clearly could be of interest. Maybe also the interferons and various other points that have actually improved their safety profile.
Rami Komrokji, MD: I believe that the crucial point is where the immune therapy would certainly fit. And I think, as you’re suggesting, maybe this is not an up front strategy. Maybe this is a upkeep strategy. We already know that from the allogeneic stem cell transplant since it is a form of immune therapy. So maybe the patients that have actually minimal residual disease, as we talked about, those are the patients that benefit. As Elias nicely summarized, I believe there are various venues. It’s certainly exciting. It opens a brand-new venue to test for the patients. yet they are not real-time prepared for patients in clinical practice.
Elias Jabbour, MD: These choices are being explored in upkeep strategy, love nivolumab single-agent in a person that is high-risk or MRD-positive, obtaining nivolumab for a year. We’re using the monoclonal antibodies anti-CD123 as a upkeep strategy. Amgen has actually a routine called BiTE: the T-cells and the myeloid cells are together. It Might visit upkeep later on. And Seattle Genetics has actually antibodies, as well, being explored, too.
Rafael Bejar MD, PhD: The various other potential role for these immune therapies—as you mentioned, the Auto T-cells—the risk is that you target a marker on the leukemia cells that’s likewise present on the typical stem cells. yet this could be used as a bridge to transplant for patients that have actually no various other mechanism to get hold of there.
Transcript Edited for Clarity
Panelists:Rafael Bejar MD, PhD, UCSD Moores Cancer Center; Elias Jabbour, MD, MD Anderson Cancer Center; Rami S. Komrokji, MD, Moffitt Cancer Center; Ruben A. Mesa, MD, FACP, Mayo Clinic Cancer Center
Published Online: Thursday, March 10, 2016
Transcript:
Ruben A. Mesa, MD, FACP: There is a focus and excitement about immunotherapy to a degree that there hasn’t been in the past. And undoubtedly in strong tumors, it has actually truly been incredibly impactful in several diseases. Exactly what do you think, Elias, in terms of immunotherapy, cellular-based therapies, Auto T-cells, PD-1 inhibitors, where do they stand particularly in this subset of myeloid diseases love AML?
Elias Jabbour, MD: You know, we’re shifting our means of treatment from killing the cancer cell to harnessing the immune system that can easily go after the cancer cells. And the proof of evidence we have, for example, is in checkpoint inhibitors, where we already know the cancer cell can easily suppress the immune system from exerting its role. The checkpoint inhibitors, PD-1 inhibitors, PD-L1, CTLA4 in melanoma, for example. In leukemia, we already know in MDS, there’s overexpression of PD-1; and, therefore, attempting to inhibit the suppression of the immune system can easily upregulate the T-cell function and kill the leukemic cells. It’s still also early.
People are calling us for immuno-oncology. It’s, like, fashionable now. Every person wishes to usage immune therapy everywhere. It doesn’t job everywhere. We have actually multiple trials at MD Anderson in MDS patients who: fall short on azacitidine or decitabine to be salvaged; or, up front, in combination in leukemia, unfit patients using nivolumab plus azacitidine; and also in patients that are young, to include nivolumab, which is a PD-1 inhibitor, to the standard backbone of chemotherapy.
I’m rather cautious ideal now. I don’t have actually outcomes to support it. We have actually the trials ongoing. Let’s wait until next year. The excitement is great, yet I don’t believe we have actually sufficient data to say immune therapy is prepared for AML. The Auto T-cells are still at the early stage. In ALL, it functions at the higher fee of safety concerns. The concern in AML is targeting the stem cell—going in to aplasia that will certainly never ever end—plus cytokine syndrome. So it’s still behind compared to ALL, even though the University of Pennsylvania group are functioning on engineering the Auto T-cell for myeloid disorders.
Ruben A. Mesa, MD, FACP: I believe you raised earlier this question of maintenance, and I believe that they deserve exploration across the board. yet as soon as I consider the intensity of AML, do immune-based responses truly fall ideal in to spots where we have actually time? Where they’ve been cytoreduced? There’s a patient that approached me that had located this paper saying that avocadoes had an anti-leukemic effect and he had 50% blasts, and would certainly that work? And I’m like, not all of the guacamole worldwide is going to position you in a CR along with your acute leukemia. yet if you had a low-intensity immune means to approach that group that have actually that higher risk, that clearly could be of interest. Maybe also the interferons and various other points that have actually improved their safety profile.
Rami Komrokji, MD: I believe that the crucial point is where the immune therapy would certainly fit. And I think, as you’re suggesting, maybe this is not an up front strategy. Maybe this is a upkeep strategy. We already know that from the allogeneic stem cell transplant since it is a form of immune therapy. So maybe the patients that have actually minimal residual disease, as we talked about, those are the patients that benefit. As Elias nicely summarized, I believe there are various venues. It’s certainly exciting. It opens a brand-new venue to test for the patients. yet they are not real-time prepared for patients in clinical practice.
Elias Jabbour, MD: These choices are being explored in upkeep strategy, love nivolumab single-agent in a person that is high-risk or MRD-positive, obtaining nivolumab for a year. We’re using the monoclonal antibodies anti-CD123 as a upkeep strategy. Amgen has actually a routine called BiTE: the T-cells and the myeloid cells are together. It Might visit upkeep later on. And Seattle Genetics has actually antibodies, as well, being explored, too.
Rafael Bejar MD, PhD: The various other potential role for these immune therapies—as you mentioned, the Auto T-cells—the risk is that you target a marker on the leukemia cells that’s likewise present on the typical stem cells. yet this could be used as a bridge to transplant for patients that have actually no various other mechanism to get hold of there.
Transcript Edited for Clarity
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