Scientific research in the field of blood cancer is advancing in great strides: treatments without chemotherapy, targeted therapies, oral medications and drug combinations increasingly effective, better tolerated and which ensure greater survival. The main innovations available to patients today, which have already entered clinical practice or have reached the final stages of experimentation, were discussed in the course of Leukemia 2021, the biennial meeting dedicated to leukemia and more, has just ended. The congress, born from the collaboration between Ail and Leukemia, was sponsored by the Italian Society of Hematology (Sie), the Italian Group for Bone Marrow Transplantation, hematopoietic stem cells and cell therapy (Gitmo) and the Gimema Foundation – Italian Group for Hematological Diseases of Adult. Ail, in addition to dealing with assistance and services for oncohematological patients, has always supported scientific research – he says Sergio Amadori, national president of Ail, Italian Association against Leukemia, Lymphomas and Myeloma -: in particular, our Association supports Gimema, which has been at the forefront for years in the production of clinical studies, many of which have represented a turning point in the treatment of some forms of tumors some blood.
Three times the chance to heal compared to 30 years ago
Among the most recent innovations that have arrived in the last three years, there is the discussion of drugs targeting the malignant mutations of acute myeloid leukemia, of the results obtained with non-chemotherapeutic drugs that lead to complete and profound remission in patients with high-risk acute lymphoblastic leukemia Phipladelpia positive and the most advanced immunotherapies such as CAR-T and bispecific antibodies, used with very encouraging results, were investigated. in aggressive non-Hodgkin’s lymphomas and myeloma. Advances in scientific research have led in the last 20 years to an extraordinary advancement in therapies for haematological neoplasms, for which the percentages of curability and healing have more than tripled compared to 30 years ago – underlines Amadori, who is also honorary professor of Hematology at the Tor Vergata University of Rome -. For some years now the so-called “precision medicine”Which through the knowledge of the mechanisms underlying blood cancers allows customize treatments with targeted therapies. I remember only one example among all, a particular form of acute myeloid leukemia called “fulminant leukemia“But technically called acute promyelocytic leukemia: the chances of surviving and healing, previously less than 20%, today are close to 95% thanks to a targeted therapy, not chemotherapy, based on arsenic trioxide combined with all-trans-retinoic acid, a derivative of vitamin A. After the identification of the molecular anomaly, Gimema contributed to the development of the treatment used on the front line and today the international standard goal for this disease.
Bispecific antibodies in lymphomas
The basic concept of this tenth Conference was the same that inspired “Leukemia” in previous editions: the narration of clinical research and basic research – he explains Angelo Michele Carella, former director of Hematology and Bone Marrow Transplants of the San Martino Polyclinic Hospital in Genoa and coordinator of the meeting -. One of the “hot topics” certainly advanced immunotherapy and, in particular, the use of bispecific antibodies in lymphomas. They are molecules that bind to two different targets at the same time: one the antigen of the tumor, the other the T cell of the immune system that are awakened to attack and kill the malignant cells. The drug on which the greatest interest is focused mosunetuzumab, a monoclonal antibody that allows the recruitment of T cells by directing their cytotoxic efficacy against lymphoma B cells. The result is to effectively counteract the most aggressive non-Hodgkin B lymphomas that are multiple relapses or refractory to conventional therapies. This medicine also it has the advantage of being ready for each individual patient, unlike the CAR-T which are prepared from time to time for each patient. Another promising cure elranatamab, a bispecific antibody (also usable intramuscularly) that binds on one hand to BCMA, a molecule expressed on the surface of multiple myeloma cells, and on the other to the CD3 receptor found on the surface of T cells, connecting them together to get an immune response. Trial results show high response rates in relapsed or refractory multiple myeloma patients, including three patients whose disease progressed after previous BCMA-inhibiting therapies.
Successes against acute myeloid leukemia
Also in acute myeloid leukemias important progress has been made in recent years with the identification of genetic markers and the development of smart and targeted drugs. After 30 years in which only chemotherapy was available, a rain of innovative treatments have arrived in the last five years that are radically changing the therapeutic profile of these pathologies. Venetoclax, for example, affects leukemia cells by inhibiting a sort of assembly line that allows the cells not to die and create resistance through the mechanism of “prolonged survival“- clarifies Amadori -. The drug binds to a specific protein called Bcl-2, present in high quantities in cancer cells which helps to prolong their survival in the body by making them resistant to anticancer drugs. By binding to Bcl-2 and blocking its action, venetoclax causes the death of cancer cells, thus slowing the progression of the disease. This drug initially used alone and with low responses in patients with advanced acute myeloid leukemia, no longer responding to traditional chemotherapies, more recently is combined with other drugs, such as azacitidine, inducing complete remissions in over 65-70% of subjects and many of these remissions are long lasting. These results are revolutionizing treatments especially in the elderly who are not eligible for intensive chemotherapy and bone marrow transplantation. Now a further advance is underway: the researchers are oriented to treat even the youngest subjects with traditional chemotherapy combined with venetoclax and the preliminary data appear promising, giving hope, in the follow-up, for long survivals. At the same time, the contributions deriving from the use of advanced forms of immunotherapy are becoming more and more numerous – concludes Amadori -. Also in acute leukemias, both myeloid and lymphoid, bispecific monoclonal antibodies are being developed. We have many in the testing phase, some with results that really bode well.
April 29, 2021 (change April 29, 2021 | 15:19)
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