Blood cancers, thus increasing the hopes of recovery even for the most seriously ill- time.news

by time news
from Vera Martinella

CAR-T and bispecific antibodies improve survival even in patients hitherto lacking alternatives. Seven out of ten Italians who fall ill with a haematological neoplasm are now alive 10 years after diagnosis

Every year about 30 thousand Italians fall ill with a blood cancer e the number of diagnoses destined to increase together with the general aging of the population, given that these are typical pathologies of old age. Fortunately, however, life expectancy today is greater and 7 out of 10 patients can aspire to recovery, as recalled by the specialists gathered in Milan for the national congress of the Italian Society of Hematology (Sie). Furthermore, rapid medical advances have made many of what were once considered deadly diseases chronic and thanks to the arrival of innovative therapies, such as CAR-T and bispecific antibodies, it is now possible to cure (perhaps even cure) adults and children. with certain types of blood cancer that left no way out until 2015. There are over 100 different subtypes of haematological neoplasms belonging to three large macro-groups: leukemias, lymphomas and myelomas, which can manifest themselves in an acute (more severe and aggressive) or chronic form – remember Paolo Corradini, President Sie -. The world of hematology has changed profoundly in the last two years and the scientific research conducted in our country opens new paths for thousands of patients to whom we could not give answers before.

CAR-T effective, safe and well tolerated

The CAR-T therapy uses particular white blood cells, the T lymphocytes, enhanced to activate the immune system against cancer cells: the patient’s T lymphocytes are taken and then genetically modified in the laboratory to enable them, once re-infused into the bloodstream, to recognize tumor cells and eliminate them, activating the immune response. There are two CAR-T approved and reimbursed today, already available for the sick in Italy, for those who have not responded or have had relapses after receiving standard care: axicabtagene ciloleucel for adults with diffuse large B-cell lymphoma and primary mediastinal large B-cell lymphoma; tisagenlecleucel for acute B-cell lymphoblastic leukemia in pediatric patients and up to 25 years of age and for diffuse large B-cell lymphoma in adults. Experience has shown that CAR-T are effective, safe and well tolerated – explains Corradini -: patient mortality is now stable at less than 3% and less than 5% of our sufferers go to ICU after receiving treatment. And the research goes on, testing these therapies on other haematological neoplasms.We then look forward to the arrival of una terza CAR-T. For example, an all-Italian study of 190 patients with aggressive non-Hodgkin’s lymphoma found that 40% recover thanks to cell therapy with CAR-T. A result obtained with a single infusion, therefore without the need for maintenance therapy, in people without any therapeutic alternative.

Being studied for different types of cancers

CAR-T have now reached an advanced stage of testing for those suffering from mantle cell lymphoma, chronic lymphocytic leukemia and myeloma – goes on Pier Luigi Zinzani, president of the Sie training activities commission -. And they are also being studied for Hodgikin’s lymphomas and acute lymphoblastic leukemia. Where we have seen that they work, then, we are testing what happens when we administer them earlier, at an earlier stage of the disease, without waiting for the patient to have already failed all other treatments. The guiding principle is to understand if we obtain a greater number of successes: the more the patient is pretreated, the greater the toxicity of a new line of therapy. For myeloma, for example in the KarMMa study (conducted in 128 heavily pretreated patients) the overall response rate reached 73% and the average survival exceeded two years in patients without alternative treatment for whom, before the arrival of CAR-T, the average life expectancy was between 6 and 9 months.

Bispecific antibodies

The new frontier of immunotherapy also consists of bispecific antibodies, which are revolutionizing the treatment of acute lymphoblastic leukemia, a rare cancer of the lymphocytes, which causes almost 800 new diagnoses in our country. for the most frequent in pediatric age: represents 80% of leukemias and about 25% of all cancers in under 14s – explains Zinzani -. The incidence peaks between the ages of 2 and 5 and then declines with increasing age. Two Italian studies can change the history of the disease. In the first, in 149 patients, thanks to the combination of the sequence consisting of chemotherapy with a bispecific antibody, a complete response of 90% was shown and molecular remission passed from 73% to 96% after the addition of the antibody. This last parameter indicates the inability to visualize a minimal amount of diseased cells with a molecular test. The second study – continues the expert – shows that It is possible to treat the disease without chemotherapy, combining targeted therapy with bispecific antibody. Remission was achieved in 98% of cases. The bispecific antibody is the basis of a new treatment principle, an innovative form of immunotherapy: it creates a sort of bridge between two different proteins, the receptor expressed on the surface of T cells and the one on the surface of B cells. immune system is stimulated to recognize cancer cells and fight them.

October 25, 2021 (change October 25, 2021 | 18:05)

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