Tag: Cancer Care

ASCO 2014: Routine Surveillance has Limited Impact in Detecting Remission of Peripheral T-cell Lymphoma

By Tiffany Tang, MD

The role of routine surveillance imaging (RSI) in first complete remission (CR1) for peripheral T-cell lymphoma (PTCL) patients is unclear. Theoretically, RSI should allow for the earlier detection of asymptomatic relapses, thus leading to the earlier initiation of second line therapy. In an abstract presented during a session of the 2014 ASCO conference, we investigated the proportion of PTCL relapses detected by RSI and those found through clinical finding, before comparing the outcomes in patients from those two groups.

341 patients were retrospectively identified through the T-cell lymphoma databases of the National Cancer Centre Singapore/Singapore General Hospital and Weill-Cornell Medical College. These patients were divided into groups based on their mode of relapse detection; through RSI or clinical findings. PTCL subtypes included PTCL-NOS, AITL, ALCL (ALK positive and negative), EATL, GDT, HSTL and ATLL, while patients with leukemias, indolent, composite and cutaneous lymphomas were excluded. Of the 341 patients, 145 patients achieved CR1 and 64 relapsed. Relapses were detected by clinical findings in 51 patients, RSI in 9 patients and only 3 patients did not have any clinical findings at the time of relapse.

This data from our findings suggests that RSI does not often impact the detection of CR1 in patients with PTCL.

Center for Lymphoma Announces the Formation of Adolescent and Young Adult Lymphoma Program

Lisa Roth, MD
Lisa Roth, MD

Recently the Center for Lymphoma announced the formation of the Adolescent and Young Adult (AYA) Lymphoma Program at Weill Cornell Medical College. The program is a collaborative effort between the Departments of Medicine and Pediatrics, and will be lead by Dr. Lisa Roth, a pediatric oncologist and new member of the Lymphoma Center.

Lymphoma is the most common malignancy in adolescents and young adults age 18-30y. While there has been remarkable progress in the treatment of children and older adults, improvements among adolescents and young adults have lagged behind. The reasons for this discrepancy are multifactorial, but include low enrollment in clinical trials, poor access to healthcare services, and a deficit in clinical and translational research in this area. The AYA Lymphoma Program seeks to advance the treatment of lymphoma in the AYA age group through the following missions:

1) Optimize medical care for AYA patients with lymphoma.

2) Provide psycho-social support tailored to AYA patients.

3) Lead clinical and translational studies aimed at improving outcomes in this age group.

Weill Cornell Medical College is in a unique position to treat AYA patients with lymphoma given the strengths of the Center for Lymphoma and the Division of Pediatric Oncology. Dr. Roth has been a Weill Cornell faculty member since joining the Department of Pediatrics in 2012. She is the Charles, Lillian, and Betty Neuwirth Clinical Scholar in Pediatric Hematology/Oncology and has been awarded fellowships from the Lymphoma Research Foundation and the Empire Clinical Research Investigator Program. Dr. Roth will work closely with a team of doctors, physician assistants, social workers, and researchers all with the common goal of improving outcomes for adolescents and young adults with lymphoma.

Ibrutinib Promotes a High Frequency of Durable Response in Relapsed/Refractory and Older Treatment Naive CLL Patients

BTK is an essential mediator of B-cell receptor signaling in normal and malignant B-cells.  Ibrutinib (PCI-32765), an oral inhibitor of BTK, promotes apoptosis and inhibits proliferation, migration and adhesion in CLL cells. Chemoimmunotherapy (CIT) treatment approaches such as fludarabine, cyclophosphamide and rituximab have markedly improved outcomes of younger, fit patients as initial or second-line therapy. Unfortunately, fludarabine-based therapy is less well tolerated in the elderly and carries significant risk of cellular immune suppression, myelosupression, and subsequent myeloid neoplasia. Additionally, virtually all patients eventually relapse after fludarabine-based CIT, leading to the need for effective salvage regimens that induce durable remissions.

Recently, at the biennial international workshop on CLL (iwCLL), in Cologne, Germany, Dr. Richard Furman presented final results from a large (n=116 patients) multi-cohort Phase Ib/II trial of ibrutinib in treatment-naive (TN) or relapsed/refractory (RR) CLL/SLL.  Patients demonstrated a high frequency of durable responses extending beyond 24 months in both TN and RR CLL/SLL including those with high-risk genomic features.

Patients who were TN (all age ≥65 years) or RR (≥ 2 prior therapies including a purine analog and with  high-risk (HR) (relapsed within 2 years from combination CIT) were treated with  ibrutinib at fixed doses of 420mg or 840mg daily until disease progression (PD). The study’s primary objective was to determine the safety and response rates of both dosing regimens.  The overall response rates for the TN and RR patients were 84% and 88% respectively.  The progression free survival (PFS) estimated at 26 months for the 85 RR patients is 74% and for the 31 TN patients is 96%. Estimated 26 month overall survival (OS) for 85 RR patients is 78% and for the 31 TN patients is 97%.  Median duration of response, PFS, and OS have not been reached at the time of this analysis.

In conclusion, Ibrutinib monotherapy was found to be highly active, well tolerated, and induced durable responses in CLL patients with high-risk disease, R/R patients, and older TN patients. At present there are ongoing randomized trials comparing the safety profile of ibrutinib with other CLL therapeutic agents. Ongoing CLL trials at Weill Cornell Medical College can be found here.