PracticeUpdate: Haematology & Oncology

AMERICAN SOCIETY OF CLINICAL ONCOLOGY 2016 ANNUAL MEETING 4

Dr Isabel Cunningham discusses key trials on haematologic malignancies presented at ASCO 2016

ASCO 2016 3–7 JUNE 2016 • CHICAGO, ILLINOIS, USA The American Society of Clinical Oncology 2016 Annual Meeting saw the presentation of key studies in glioma, pancreatic cancer, lung cancer, haematologic cancers and much more. PracticeUpdate Oncology Associate Editor Dr Isabel Cunningham and Advisory Board member Dr Jeffrey Kirshner discuss their top abstracts from ASCO 2016.

Isabel Cunningham MD is Adjunct Associate Research Scientist, Division of Hematology Oncology, Columbia University College of Physicians and Surgeons in New York.

Leukaemia, myelodysplastic syndromes, and allotransplant Optimizing chimeric antigen receptor (CAR) T cell therapy for adult patients with relapsed or refractory (r/r) acute lymphoblastic leukemia (ALL). NV Frey, PA Shaw, EO Hexner, et al • Researchers evaluated 27 adults with relapsed or refractory acute lymphoblastic leukaemia (ALL) who received CTL019 in one of four dosing cohorts. Objective response rate (ORR) was greatest at 83% with CTL019 dosed at 5 x 10 8 with fractionated dosing. ORRwas 33%with 5 x 10 7 and 50% with a single dosing of 5 x 10 8 . A total of 9 of 12 patients receiving fractionated CTL019 had grade 3 or higher cytokine release syndrome, compared with 6 of 6 patients receiving a single dose of 5 x 10 8 CTL019 and 6 of the 9 patients receiving 5 x 10 7 . • Researchers concluded that split dosing may maintain efficacy while reducing the toxicity of CTL019 in adults with relapsed or refractory ALL. Impact of disease burden on long-term outcome of 19-28z CAR modified T cells in adult patients with relapsed B-ALL. JH Park, I Riviere, X Wang, et al • In this phase I trial, 46 adults with relapsed or refractory B-cell acute lymphoblastic leukaemia (B-ALL) received lympho-depleting chemotherapy followed by 19–28z chimeric antigen receptor (CAR) T-cell infusion. Complete response was observed in 91% of patients with minimal disease burden (<5% blasts) at baseline and 75% of patients with morphologic disease burden ( ≥ 5% blasts). While 44% patients with morphologic disease burden experienced severe cytokine release syndrome, it did not occur in any of the patients with minimal disease burden. Grade 3 to 4 neurotoxicity also occurred more frequently with morphologic versus minimal disease burden (40% vs 14%, respectively),

and 6-month overall survival rate was 57% and 73%, respectively. • Researchers concluded that 19–28z CAR T-cell infusion is effective for adults with relapsed and refractory B-ALL. Minimal disease burden is associated with better outcomes. Inotuzumab ozogamicin (InO) for relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL) in the phase III INO-VATE trial: Efficacy and safety by prior therapy. DJ DeAngelo, E Jabbour, M Stelljes, et al • In this ongoing phase 3 INO-VATE trial, researchers evaluated 109 patients with relapsed or refractory acute lymphoblastic leukaemia (ALL) receiving inotuzumab ozogamicin (InO) to determine the impact of prior therapy on efficacy and safety. In patients who received InO as salvage (S) 1, response was numerically higher, remission duration was longer, and rates of hepatobiliary adverse events were significantly lower compared with patients who received InO as S2. Prior stem cell transplant (SCT) was associated with a numerically lower rate of complete remission with incomplete haematologic recovery and a numerically higher rate of hepatobiliary adverse events compared with no prior SCT. • Prior therapy and SCT increase the risk for hepatotoxicity in patients taking InO; however, patients with relapsed or refractory ALL receiving InO as S1 or S2 therapy may gain clinical benefit. Impact of complete molecular response (CMR) on survival in patients with Philadelphia chromosome- positive (Ph+) acute lymphoblastic leukemia (ALL). NJ Short, E Jabbour, JE Cortes, et al • In a single-institution study, outcomes of 202 adult patients with Philadelphia chromosome- positive (Ph+) acute lymphoblastic leukaemia (ALL) were assessed to determine the association of complete molecular response (CMR) with survival.

PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY