Articles related to Hematology/Oncology

Outcomes from the large PETHEMA registry study shows that secondary AML is common (27% of AML cases) and has a median OS of 5.6 months vs. 10.9 months for primary AML, and has various differing characteristics compared to primary AML. These include older age at diagnosis, more high-risk cytogenetics, less FMS-like tyrosine kinase three internal tandem duplication, fewer NPM1 mutations, and received a lower intensity of chemotherapy.

The interpretation of genomic sequencing data is complex. Not all tumors have alterations within therapeutically targetable or actionable genes, and not all alterations detected within a therapeutically actionable gene may confer sensitivity to genomic biomarker–linked therapies. ASCO’s expert panel provides a provisional opinion, giving guidance on using genomic sequencing to inform treatment selection for patients with metastatic or advanced solid tumors.

Double-hit lymphoma presents as both aggressive, systematic disease with extra-nodal involvement and, apparently, as low-stage, less clinically aggressive disease. Since R-CHOP is much less effective in double-hit lymphoma, options such as CAR-T as well as novel drugs targeting cell-surface markers are being investigated. This interview with Dr. Ann S. LaCasce of Dana Farber summarizes current understanding and approaches to double-hit lymphoma.

Initial results of the PREOPANC trial — comparing the addition of neoadjuvant chemoradiation therapy of gemcitabine combined plus Gy radiotherapy to standard care — failed to demonstrate a statistically significant overall survival (OS) improvement versus standard care of upfront surgery followed by adjuvant therapy. The long-term results, however, demonstrate significant benefit with neoadjuvant chemoradiation therapy consisted of gemcitabine combined plus Gy radiotherapy. The five year OS rate was 20.5% (95% CI, 14.2 to 29.8) with neoadjuvant chemoradiotherapy and 6.5% with upfront surgery.

Interest in immune-modulating neoadjuvant therapy for melanoma is growing. It is possible that BRAF/MEK inhibition will be more effective in the neoadjuvant than in the adjuvant setting because of the effect of the tumor biomass. And the benefits neoadjuvant therapy would offer in assessing biologic response assessment to treatment are significant. In this review the authors discuss the rationale for this treatment approach, summarize completed and ongoing neoadjuvant clinical trials, and contextualize these findings within the growing body of knowledge about targeted and immune checkpoint therapy.

Extending the ELEVATE-TN to four additional years (beyond the two-year follow-up in the pivotal trial) showed ongoing efficacy with no new safety signals. Additionally, the four year ELEVATE-RR trial comparing acalabrutinib with ibrutinib as monotherapy in high-risk populations showed overall non-inferiority of acalabrutinib and a lower rate of several adverse events, including atrial fibrillation.