Weekly Spotlight - 10.10.24

In the News

Lymphoma Symptoms: Six Survivors Share Their Experiences

Lymphoma, a type of blood cancer, presents with symptoms such as night sweats, unexplained weight loss, and persistent fevers. These symptoms, known as B symptoms, are more prevalent in aggressive lymphomas, which grow rapidly and can cause significant tissue damage. Indolent lymphomas, in contrast, grow slowly and may not exhibit symptoms immediately. The experiences of six survivors highlight the varied manifestations of lymphoma, including swollen lymph nodes, persistent coughs, and severe itching. These accounts underscore the importance of recognising and addressing symptoms promptly, as early detection can significantly impact treatment outcomes.

Medical professionals advise seeking consultation if symptoms persist beyond two weeks. Some symptoms, like spinal cord compression and superior vena cava obstruction, require immediate medical attention due to their severity. Understanding the nature of lymphoma symptoms and their potential implications is crucial for timely diagnosis and intervention. This knowledge empowers individuals to seek medical advice when necessary, potentially improving prognosis and quality of life. The narrative of these survivors serves as a reminder of the diverse ways lymphoma can manifest, urging vigilance and awareness in monitoring one's health.

New Immunotherapy Achieves High Success in Mantle Cell Lymphoma Treatment

A recent clinical trial led by the Peter MacCallum Cancer Centre has demonstrated promising results for a new immunotherapy drug, glofitamab, in treating mantle cell lymphoma (MCL), a rare and aggressive form of non-Hodgkin lymphoma. The trial involved 60 patients with relapsed or treatment-resistant MCL, achieving a complete response rate of 78% and an overall response rate of 85%. These findings are particularly significant given the typically poor prognosis for MCL patients, especially those who have previously been treated with bruton tyrosine kinase inhibitors (BTKi). The trial's success suggests a potential shift in treatment practices, although further validation is awaited from an ongoing Phase III trial.

The trial also explored the use of obinutuzumab as a pre-treatment to mitigate the risk of cytokine release syndrome (CRS), a common side effect of immunotherapy. Despite CRS occurring in 70% of participants, it was deemed manageable with appropriate support. This research underscores the potential of glofitamab to improve outcomes for MCL patients, offering hope for a cancer often considered incurable. The results have been published in the Journal of Clinical Oncology, marking a significant step forward in the treatment of hard-to-treat blood cancers.

Sequencing Strategies for Relapsed/Refractory Mantle Cell Lymphoma Treatments

Dr Craig A. Portell's session at the 2024 Society of Hematologic Oncology Annual Meeting delves into the complexities of sequencing therapies for relapsed/refractory mantle cell lymphoma. As resistance to Bruton's tyrosine kinase (BTK) inhibitors becomes more understood, the challenge lies in determining subsequent treatment steps. Portell highlights the promising role of chimeric antigen receptor (CAR) T-cell therapy in this context. He anticipates that further data on bispecific antibodies, covalent BTK inhibitors, and venetoclax will aid in addressing these challenges, offering insights into managing patients post-progression with various disease characteristics.

Portell's presentation will explore decision-making processes for patients exposed to BTK inhibitors and the integration of CAR T-cell therapy versus non-covalent BTK inhibitors. Special scenarios, such as p53-mutated relapse disease, will also be discussed. The session aims to provide informative pathways for managing relapsed scenarios, contributing to a broader understanding of lymphoma treatment strategies. Overall, the lymphoma sessions promise to be well-reviewed and insightful, offering valuable perspectives for both Portell and his colleagues.

Acalabrutinib Gains Priority Review for Untreated Mantle Cell Lymphoma

The FDA has granted priority review to acalabrutinib for patients with untreated mantle cell lymphoma (MCL), based on promising results from the phase 3 ECHO trial. This trial demonstrated that acalabrutinib, when combined with bendamustine and rituximab, significantly extended progression-free survival compared to a placebo. The median progression-free survival was 66.4 months for the acalabrutinib group versus 49.6 months for the placebo group. Although overall survival rates were not significantly different, the trial allowed patients in the placebo group to switch to acalabrutinib upon disease progression, which may have influenced these results.

The ECHO trial, a multicentre, double-blind study, enrolled patients aged 65 and older with untreated MCL. Participants received either acalabrutinib or a placebo alongside six cycles of chemoimmunotherapy. The trial's findings underscore acalabrutinib's potential to transform treatment outcomes for this incurable blood cancer. The FDA's priority review acceptance highlights the urgency of making this treatment available, with a decision expected in early 2025. The study also reported on safety, noting that treatment-emergent adverse effects were common but manageable.

B-Cell Lymphoma Treatment Market: Current Trends and Future Prospects

The B-cell lymphoma treatment market is experiencing significant growth, driven by advancements in medical technology and an increasing incidence of the disease. Traditional therapies like chemotherapy and radiation have been supplemented by innovative treatments such as targeted therapies and CAR-T cell therapies, which are transforming cancer care. The market, valued at USD 6,360.75 million in 2022, is projected to reach USD 13,145.36 million by 2030, with a CAGR of 8.4%. Diffuse Large B-Cell Lymphoma (DLBCL) remains the most prevalent subtype, necessitating continued research and development to improve patient outcomes.

Current trends in the market include a shift towards personalised medicine, with targeted therapies and immunotherapies gaining popularity due to their precision and reduced side effects. Combination therapies are also emerging as a promising approach, enhancing treatment efficacy and reducing recurrence risks. The Asia-Pacific region is poised for substantial growth, driven by economic expansion, increased healthcare spending, and heightened cancer awareness. Regulatory bodies are expediting approvals for breakthrough therapies, broadening access to advanced treatments and improving survival rates for patients with aggressive B-cell lymphomas.

Advances in Mantle Cell Lymphoma: Frontline and Relapsed Treatment Insights

Recent research into mantle cell lymphoma (MCL) highlights promising advancements in frontline therapies, yet challenges persist in the relapsed/refractory context. For older patients, the bendamustine-rituximab regimen remains standard, with cytarabine showing potential despite increased toxicity. Younger patients benefit from intensive chemoimmunotherapy, often followed by stem cell transplants, with second-generation Bruton tyrosine kinase inhibitors emerging as promising alternatives. However, the SHINE trial revealed that while ibrutinib enhances progression-free survival, it does not improve overall survival due to its toxicity, leading to its removal from the FDA label.

In the relapsed/refractory setting, the need for improved treatments is evident, particularly after Bruton tyrosine kinase inhibitors or CAR T-cell therapy. Noncovalent inhibitors offer some hope, though resistance mutations pose challenges. Innovative approaches, including molecular glues, novel inhibitors, and bispecific antibodies, are under investigation, with early data suggesting potential benefits. These developments underscore the ongoing quest for effective MCL treatments, with clinical trials playing a crucial role in advancing therapeutic options.