IMMUNOTHERAPY

Even as immunotherapy grows more popular as a treatment for solid tumors, physicians are racing to identify patients with the molecular subtypes, rather than the disease, who will derive the most benefit.

As checkpoint inhibition is increasingly being utilized beyond the scope of clinical trials, it’s essential that community-based oncologists and physicians learn how to quickly diagnose and treat immune-related adverse events.

<strong>IN THIS ISSUE, INVESTIGATORS FROM</strong> Emory Winship Cancer Institute describe their experience with the so-called &ldquo;abscopal effect,&rdquo; which describes the ability of locally delivered radiation therapy to trigger distant antitumor effects. R. H. Mole, BM, FRCP, first coined the term abscopal effect as &ldquo;an action at a distance from the irradiated volume but within the same organism&rdquo; in 1953.

The rising costs of drugs continue to impede cancer program growth, and new technology remains a boon and a bane, depending on its utility for expanding practice capability or its inflexibility to needs, according to the 2017 Trending Now in Cancer Care Survey from the Association of Community Cancer Centers, based in Rockville, Maryland.

The prognosis for patients with metastatic non&ndash;small cell lung cancer (NSCLC) is poor.&nbsp;However, with recent trials showing improved overall survival with checkpoint inhibitors compared with standard chemotherapy, disease management is changing.

Updated findings from the phase III KEYNOTE-045 trial confirmed the benefit of&nbsp;pembrolizumab (Keytruda) compared with chemotherapy in pretreated patients with locally advanced or recurrent urothelial cancer. Two-year follow-up of the trial presented at the 2018 Genitourinary Cancers Symposium demonstrated that overall survival was improved with pembrolizumab.

Based on data from part 1a of the phase III CheckMate-227 trial, nivolumab (Opdivo) and&nbsp;ipilimumab (Yervoy) in combination show improved progression-free survival (PFS) versus with chemotherapy in treatment-na&iuml;ve patients with high tumor mutation burden (TMB) non&ndash;small cell lung cancer (NSCLC).

Arjun Balar, MD, recently shared the treatment considerations and decisions he makes when treating patients with advanced bladder cancer.

Multiple Myeloma

The emerging arena of checkpoint inhibitors and immunotherapy in the treatment of urothelial carcinomas is explored and discussed.

Hyperprogressive disease (HPD) after immunotherapy treatment may not be as rare of a phenomenon as previously thought. A recent multicenter, retrospective analysis of 242 patients with advanced non&ndash;small cell lung cancer&nbsp;(NSCLC) found that 16% of patients developed hyperprogression during anti&ndash;PD-1/ PD-L1 treatment.¹ The study, which was presented at the 2017 ESMO Annual Congress, is one of the latest to highlight the risk of hyperprogression.

The overwhelming majority of patients with cancer who appear to progress after they begin immunotherapy will never respond. They will continue to progress, just as quickly as they would with no treatment and just as predicted by the Response Evaluation Criteria in Standard Tumors (RECIST) criteria that have long guided most trial evaluations and many treatment decisions.

An extension in overall survival (OS) with the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) has completely changed the standard of care for patients with metastatic renal cell carcinoma (mRCC), Thomas Powles, MD, MBBS, MRCP, told audience members during the 9th European Multidisciplinary Meeting on Urological Cancers.<br /> &nbsp;

Eli Lilly and Company has announced that Kimberly L. Blackwell, MD, a pioneer in breast cancer research, will serve as its vice president of early phase development and immuno-oncology. She will begin her new role on March 12, 2018.<br /> &nbsp;

Chimeric antigen receptor T-cell therapy with bb2121 demonstrated an objective response rate of 94% in patients with&nbsp;relapsed/refractory multiple myeloma, according to findings from a dose-escalation study. The senior study author, James N. Kochenderfer, MD, presented updated findings from the study during the 2017 ASH Annual Meeting, and commented that 89% of patients had a very good partial response or better, and 56% of patients had a complete remission.&nbsp;<br /> &nbsp;

The combination of brentuximab vedotin (Adcetris) and nivolumab (Opdivo) demonstrated promising clinical activity in patients with&nbsp;relapsed/refractory Hodgkin lymphoma,&nbsp;according to results from a phase I/II trial presented at the 2017 ASH Annual Meeting.

Pembrolizumab (Keytruda) has received a priority review from the FDA for a supplemental biologics license application (sBLA) for the treatment of&nbsp;adult and pediatric patients with relapsed/refractory primary mediastinal large B-cell lymphoma (PMBCL), according to a press release from Merck,&nbsp;the manufacturer of pembrolizumab. The findings were first presented at the 14th International Conference on Malignant Lymphoma and updated data were recently presented at the 2017 ASH Annual Meeting.

Updated results from the TRANSCEND study demonstrated that&nbsp;liso-cel (lisocabtagene maraleucel), formally known as JCAR017, induced an 81% objective response rate and a 63% complete remission rate in patients with relapsed/refractory diffuse large B-cell lymphoma.

In results from the phase Ib/II PANACEA trial presented at the 2017 San Antonio Breast Cancer Symposium (SABCS), the combination of pembrolizumab (Keytruda) and trastuzumab (Herceptin) achieved an objective response rate (ORR) of 15.2% in patients with trastuzumab-resistant, PD-L1&ndash;positive, HER2-positive breast cancer.

The objective response rate with neoadjuvant nivolumab (Opdivo) plus ipilimumab (Yervoy) was almost tripled compared with nivolumab alone in patients with high-risk resectable melanoma, according to preliminary findings from a phase II study presented during the 32nd SITC Annual Meeting.

Four researchers from the Dana-Farber Cancer Institute are joining the Parker Institute for Cancer Immunotherapy as a result of a collaboration between the 2 institutions: W. Nick Haining, BCh, BM; Catherine Wu, MD; Philip Kranzusch, PhD; and F. Stephen Hodi, Jr., MD.

The treatment armamentarium of neuroendocrine tumors (NETs) is expanding to potentially include novel systemic therapies, a refined understanding of genetic changes in patients with pancreatic NETs, and improvements in surgical timing and quality of life (QoL), according to Diane Reidy Lagunes, MD.

In a small phase I study, engineered tumor-infiltrating lymphocytes demonstrated signs of antitumor activity in patients with metastatic melanoma following treatment with a prior checkpoint inhibitor. Results of the pilot study of TILs that were engineered to express&nbsp;transforming growth factor-&beta; dominant negative receptor and nerve growth factor receptor were presented during the 2017 World Congress of Melanoma.

Howard L. Kaufman, MD, FACS, has been appointed chief medical officer of Replimune Group Inc, a developer of oncolytic immunotherapies for the treatment of cancer. Kaufman has 25 years of leadership in academic oncology and is recognized as one of the leading physician scientists in the oncolytic immunotherapy field.