Dr Ann LaCasce Discusses Potentially Game-Changing Treatments for Lymphoma

Ann LaCasce, MD, MMSc, director of the Dana-Farber/Mass General Brigham Fellowship in Hematology/Oncology and chair of the Lymphoma Research Foundation’s scientific advisory board, discussed the changing lymphoma treatment landscape and highlighted potentially game changing treatments.

Transcript

Immunotherapies have been moving to earlier lines of therapy, both alone and in combination with chemotherapy. How might these treatment options and sequencing for lymphomas evolve in the near future based on the current landscape and pipeline?

I think we know that these—the bispecifics in particular—are very combinable, and they're very active. So I think we will begin to see these being used more and more in clinical trials upfront in indolent lymphomas and then combining them with chemoimmunotherapy in aggressive lymphomas. I think that in Hodgkin lymphoma, we are likely, I didn't mention that before, but I think we're likely to see hopefully a publication from the S1826 trial comparing brentuximab plus AVD [doxorubicin, vinblastine, and dacarbazine] to nivolumab plus AVD, and I think this is going to be a major game changer and change how we initially treat patients. So I think, you know, the goal here is to have long-term remissions in as many patients as possible up front, and then continue to develop drugs for those patients who fail, but it's really a very exciting space.

As we begin to see more longer-term data on newer generation BTK inhibitors, including data in CLL presented at ASH 2023, how do you see this area evolving in the near future?

We've really seen in the past year or 2, particularly in the US, we're not really using ibrutinib anymore. I mean, this was a real game changing drug that changed the prognosis of CLL. It was really dramatic when we first started using this drug, but we now know the next generations are better tolerated and very active. So now I think the question is the noncovalent BTK inhibitors like pirtobrutinib, which have even more favorable toxicity profiles than the the approved BTK inhibitors. So I think it's going to be very interesting to see how they compare in previously untreated patients, to know whether maybe we're going to be going to these noncovalent ones, as our initial frontline therapy—but we have some work to do is to compare those and really look at the data. But I think, overall, there's just been such incredible changes in how we manage this disease, I think maybe of any of the diseases we treat from when I started as a fellow and we were using chemoimmunotherapy and patients really didn't do well and had a lot of toxicity. And now, I think chemoimmunotherapy is very rarely even considered in CLL, even in our most favorable young patients who are mutated.