Reasons for Optimism in Combating Aggressive Blood Cancers | The Doctor Weighs In
By: The Doctor Weighs In
Tags: Blood, Cancer, Oncology, Optimism

By: Alex Herrera, M.D.

New medicines, diagnostics, and discoveries give patients more options and more hope.

Multipipette for cancer research Photo source: iStock

September is Blood Cancer Awareness Month

As a hematologist-oncologist, the occasion always reminds me to reflect on how far we’ve come in treating blood cancers. And also think about what lies ahead. Blood cancers still have a devastating impact across the United States. However, we have made great progress and there are some big reasons to be optimistic about the future.

Blood cancers may sound like a rare category of diseases, but with more than a million people in the United States now living with, or in remission from, a blood cancer, it is likely that you know someone who has been impacted by the disease.[1]

There are three main types of blood cancer:

The most common is lymphoma, with non-Hodgkin’s lymphoma, or NHL, being the most common subtype. NHL itself is not one disease, but rather encompasses more than 60 different types of blood cancers that can be either indolent (slow-growing) or aggressive (fast-growing).[2] In these cancers, certain immune cells grow uncontrollably, ultimately leading to improper immune function.

Over the last quarter-century, our understanding of these cancers has evolved greatly, enabling significant improvements in treatment. Looking specifically at NHL, the 5-year survival rate has increased from 52 percent to 75 percent since the early 1990s, and it is projected to continue to rise.[3] Within NHL, one of the best examples of our progress in treating aggressive blood cancers is a form called diffuse large B-cell lymphoma (DLBCL).

Challenges in treating aggressive blood cancers

DLBCL is the most common aggressive form of NHL. Nearly 25,000 people are diagnosed with it in the United States every year.[4] While the progress in treating DLBCL has been encouraging, there is still a need for more treatment options.

This is especially true for the two in five people who are either not responsive to treatment initially or see their cancer go into remission and then return. This is known as relapsed/refractory (R/R) DLBCL. [6] Given the fast-growing nature of this cancer, therapies that can rapidly relieve the burden of disease in R/R DLBCL are necessary.

People with R/R DLBCL have several treatment options, including more aggressive chemotherapy and possibly a stem cell transplant, or immunotherapy treatments like CAR T-cells. While effective for many patients, some people are ineligible for these treatments due to age or other factors. Others relapse again after therapy. New treatment options are crucial so that we can provide effective therapies for patients regardless of the stage of their disease.

Another option for previously treated patients

The U.S. Food and Drug Administration recently granted accelerated approval to a new treatment option for people with R/R DLBCL, called polatuzumab vetodin-piiq (Polivy). This medicine has garnered excitement because it is directed against a particular molecule called CD79b.

That property enables the medicine to carry chemotherapy to specific B-cells, including cancerous ones. In contrast, traditional chemotherapy courses throughout the body affecting not only the cancer cells but other normal cells as well. Because the medicine is targeted to specific B-cells, it can deliver higher doses of chemotherapy to destroy the cancer while limiting damage to healthy cells.

Of the patients treated with Polivy, 40 percent achieved a complete response in the clinical trial that supported the medicine’s approval, meaning that no cancer could be detected in their bodies after treatment and the medicine was also generally well-tolerated among patients.

In addition to being clinically effective, the medicine is relatively simple to administer and is a readily available therapy that is administered in an outpatient setting.

New tests for new treatments

Polivy comes onto the scene at a time when advancements in science and technology are increasing rapidly for blood cancer patients. All of these new medicines are helping patients live longer than ever before.

As it often happens, that progress has introduced a new — but welcome — challenge. In an era when treatment options are abundant, choosing the best option in a crowded space can be tricky.

New technologies to assess treatment response and progression are critical. Methods like minimal residual disease (MRD) — a sensitive test to detect the presence of cancer cells after treatment to more precisely assess how a patient responds to treatment — can help care teams determine treatment response and make decisions about appropriate next steps more efficiently. Additionally, using technology to better categorize patients into risk groups can allow physicians to design and prescribe the right treatments based on disease stage and progression.

The advances made in blood cancer treatment over the last several years are encouraging. It is an exciting time to be a physician treating patients and to see them generally thriving longer than similar patients did a generation ago. As time goes on, we are seeing what used to be a devastating diagnosis turning into a chronic, manageable disease. I hope to see even more advances in the coming years, and someday to be able to provide all patients with effective options throughout their treatment journey.

If you or someone you know needs to learn more about blood cancers, treatment, research and support services, patient advocacy groups like the Lymphoma Research Foundation and Leukemia & Lymphoma Society are dedicated to helping blood cancer survivors and their families feel supported, connected and engaged. For additional resources and support services, please visit: Lymphoma Research Foundation, Leukemia and Lymphoma Society or City of Hope.

Other Cancer Related Articles:

Precision Medicine is Changing the Way We Think About Cancer

Liquid Biopsy for Cancer: What You Need to Know

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References

[1] American Cancer Society. Types of B-Cell Lymphoma. Available at: https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/b-cell-lymphoma.html.

[2] Swerdlow S.H., et al. WHO Classification of Tumors of Haematopoetic and Lymphoid Tissues. IARC: Lyon 2008.

[3] NCI. Cancer Stat Facts: Non-Hodgkin Lymphoma. Available at: https://seer.cancer.gov/statfacts/html/nhl.html

[4] American Cancer Society. Types of B-Cell Lymphoma. Available at: https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/b-cell-lymphoma.html.

[5] American Cancer Society. Key Statistics for Non-Hodgkin Lymphoma. Available at: https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/key-statistics.html

[6] Maurer JM, et al. Event-free survival at 24 months is a robust endpoint for disease-related outcome in diffuse large B-cell lymphoma treated with immunochemotherapy. J Clin Oncol. 2014;32:1066–73.

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Alex Herrera, M.D. is an assistant professor in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope Comprehensive Cancer Center in Duarte, California. As a board-certified hematologist and medical oncologist, his clinical and research interests are focused on immunotherapy and hematopoietic stem cell transplantation in patients with lymphoma. He has published over 40 articles in peer-reviewed publications, abstracts and book chapters, and has been invited to present his work nationally and internationally. Dr. Herrera is an active member of the American Society of Clinical Oncology, the American Association for Cancer Research, the American Society of Hematology, American Society of Blood and Marrow Transplantation and the Southwest Oncology Group. Dr. Herrera has been the recipient of several honors, grants and awards, including the Leukemia & Lymphoma Society Scholar in Clinical Research Award, American Society of Blood and Marrow Transplantation/Biology of Blood and Marrow Transplantation George Santos Award for Best Clinical Science Article by a New Investigator and American Society of Clinical Oncology/Conquer Cancer Foundation Young Investigator Award, among others.