The Targeted Pulse: Navigating Rapid Guidelines Changes in Breast Cancer, a New Gene Therapy, and More

Bispecific Antibodies Is A Better Alternative for B-Cell Lymphoma

B-cell lymphomas present challenges for traditional therapies because of delayed treatment and harsh adverse events. Bispecific antibodies offer a promising alternative, providing off-the-shelf options with quicker treatment initiation. Already approved for follicular and diffuse large B-cell lymphomas, bispecific antibodies now show efficacy in mantle cell lymphoma.

“We see prolongation in both progression-free survival and duration of response… This is further ammunition to support our broader deployment of mosunetuzumab [Lunsumio] in care settings…we also found no new safety signals as we follow the cohort over time, reaffirming that this is treatment that is appropriate for community-based settings,” Matthew Matasar, MD said. Matasar is chief of the division of blood disorders at the Rutgers Cancer Institute and professor at the Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ.

Hope Presents In The Current Landscape of Triple-Negative Breast Cancer

Triple-negative breast cancer (TNBC) is a challenging subtype compared with its counterparts. Despite improved accuracy, treatment options remain limited compared with other subtypes of breast cancer. Findings from the KEYNOTE-522 trial (NCT03036488) demonstrated a significant increase in pathological complete response (CR) rates vs chemotherapy alone bringing hope to the scene.

“Pathologic CR was initially reported at almost 65% in the original 2020 paper vs about 50% in the control arm. That is a pathologic CR that’s about 14% better and that’s huge,” Daniel Carlson, DO said. Carlson is an oncologist in Minneapolis, Minnesota and is affiliated with Allina Health Mercy Hospital-Coon Rapids. “I think that the outcomes are better with the advent of immunotherapy, but we still have a considerable area of unmet need where we are not achieving pathologic CRs,” he explained.

Challenges Arise with Rapidly Changing Guidelines in HER2-Positive Breast Cancer

“The rapidly evolving evidence in the treatment of metastatic HER2-positive breast cancer presents challenges in aligning practice with the latest clinical data and guideline recommendations, especially for physicians that treat multiple tumor types,” Reshma Mahtani, DO, stated. Mahtani is chief of breast medical oncology at Miami Cancer Institute, Baptist Health South Florida and discussed findings from a quality improvement initiative that was presented at the 2023 San Antonio Breast Cancer Symposium.

“In terms of our findings,” Mahtani began, “the top reported health care professional challenges included coordination of care [and] individualizing treatment plans, whereas the top patient-reported challenges included things like feeling confident in their treatment plan and being unable to meet work or home responsibilities…“What I found personally most striking is the discordance in perceptions between patients and those who care for them,” she said.

New Gene Therapy Boosts Immune Reconstitution After Transplant

A new gene therapy with cell products has the potential to expedite the immune reconstitution process in pediatric and young adult patients with hematologic malignancies. A phase 1/1b study (NCT04640987) combined T-cell immunotherapy, T-allo10, which is generated in vitro from donor CD4-positive T cells and enriched in type 1 regulatory cells, with the goal of suppressing host-reactive T cells that cause graft-vs-host disease.

“This approach targeted the very high-risk population, which without a transplant cannot be cured, and is optimizing the outcome that the transplant itself can give,” Alice Bertaina, MD stated, who is one of the study investigators on the trial. “No patients transplanted so far with this approach had transplant-related mortality, which is absolutely excellent considering the very high-risk population,” she explained.

Amivantamab/Chemo Approved for Advanced EGFR Exon20Ins Mut+ NSCLC

Amivantamab-vmjw (Rybrevant) is now FDA-approved for patients with EGFR exon 20 insertion mutation-positive non-small cell lung cancer. This approval is based on the phase 3 PAPILLON trial (NCT04538664). Amivantamab, along with carboplatin and pemetrexed, showed a statistically significant improvement in progression-free survival when compared with carboplatin and pemetrexed.

“Bringing amivantamab upfront with chemotherapy for EGFR exon 20 insertions may change the standard-of-care,” Jonathan W. Riess, MD, stated in an interview with Targeted Oncology. Riess is the medical director of thoracic oncology at the University of California, Davis Comprehensive Cancer Center.

Thank you for joining us for this week’s Targeted Pulse. Look out for more recaps to come.