Cancer Topics - New Therapies for Lymphoma (Part 1)

10/15/21 • 26 min

In part one of this two-part ASCO Education Podcast episode, Dr. Sonali Smith (University of Chicago Medicine) and Dr. Paolo Strati (MD Anderson Cancer Center) discuss the application of recently approved therapies for diffuse large B-cell lymphoma through examination of challenging patient cases.

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Air Date: 10/20/21

TRANSCRIPT

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SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

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SONALI SMITH: Hello, and welcome to this episode of the ASCO Education Podcast highlighting new therapies for lymphoma. My name is Dr. Sonali Smith, and I'm a hematologist and medical oncologist specializing in lymphoma and clinical investigation in lymphoma. I'm also the Elwood V. Jensen Professor and chief of the hematology/oncology section at the University of Chicago, and very excited to be joined by my colleague, Dr. Paolo Strati.

PAOLO STRATI: Good morning to everybody. My name is Paolo Strati. I'm a hematologist and medical oncologist and an assistant professor in the Department of Lymphoma/Myeloma, and in the Department of Translational Molecular Pathology at MD Anderson Cancer Center, Houston, Texas. And I'm also the clinical director for the Lymphma Tissue Bank.

In part one of this podcast episode, we will discuss the adoption of recently approved therapies for diffuse large B-cell lymphoma, such as selinexor, tafasitamab, Liso-Cel, and Lonca-T. These therapies have transformed care for patients with this disease. And we'll start our conversation today with a patient case.

SONALI SMITH: Great. Well, I'll go ahead and present a patient to you, Paulo. So this is a 78-year-old man with diffuse large B-cell lymphoma that is the germinal center-derived subtype. It is not double expressor, it is not double-hit. He has advanced stage disease with a high IPI, as well as the high CNS IPI. Luckily, his performance status is zero and he has no significant comorbidities or other health conditions.

He received frontline dose-adjusted EPOC-R with intrathecal methotrexate for six cycles. But at the end, he had a partial remission. So how do you select your salvage therapy in this situation? Are you concerned about using agents targeting CD19 in the second line, given the potential need to use anti-CD19 cellular therapy, or CAR-T in the third line?

PAOLO STRATI: This is a very interesting and unfortunately not uncommon case. And thank you, Sonali, for asking these very important questions. Technically, a platinum-based regimen followed by autologous transplant will be a standard answer and may be feasible. Because as you mentioned, this patient has a good performance status and non-meaningful comorbid health conditions.

However, patients who are refractory to a frontline anthracycline-based regimen, such as in this case, with achievement only of partial remission at the end of frontline dose-adjusted EPOC, can potentially experience a suboptimal outcome following the standard approach with a platinum-based second line regimen. And as such, alternative strategies may be needed.

To this regard, the combination of tafasitamab that, as you know, is a monoclonal antibody targeting CD19, and lenalidomide, an oral immunomodulatory agent, a combination which is currently approved by the FDA in the United States as a standard second line option for transplant ineligible patients, would be a great option in this case.

Data from the three year follow-up of the phase II study that has brought to the FDA approval this combination, the L-MIND had been recently presented and have showed the complete remission rate of 40% and immediate duration of response of 44 months, including patients who received this regimen as a third line or beyond.

So there is, of course, a biological concern by targeting CD19 in second line. These may potentially impact a third line use of an autologous anti-CD19 CAR-T, because CD19 downregulation may potentially be a mechanism of escape to tafasitamab. And recent data has shown the CD19 levels are strongly associated with t...

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Air Date: 10/20/21

TRANSCRIPT

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Oncology, Etc. - In Conversation with Dr. Otis Brawley (Part 2)

In the second edition of this two-part Oncology, Etc. episode, hosts Dr. Patrick Loehrer (Indiana University) and Dr. David Johnson (University of Texas) continue their conversation with Dr. Otis Brawley, a distinguished professor of Oncology at Johns Hopkins and former Executive Vice President of the American Cancer Society.

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Air Date: 10/5/2021

TRANSCRIPT

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DAVID JOHNSON: Welcome back to Oncology, Etc, and our second segment of our conversation with Otis Brawley, professor of Medicine at Johns Hopkins Medical School and the Bloomberg School of Public Health. Pat, I don't know about you, but Otis is a very impressive man, and he had a lot of really interesting things to say about his career development, family, et cetera in the first segment. This second segment, we're going to get to hear more about his time at the ACS. What were your thoughts about segment one?

PATRICK LOEHRER: Well, I loved talking to Otis, and you too, Dave. Parenthetically, Otis once told me in a dinner conversation we had that he felt like Forrest Gump, and I can identify with that. Where over the field, our field of oncology over the last several decades, we've met some incredibly wonderful people, and we've been lucky to be part of the history. The three of us, I think, do have a deep sense of the historical context of oncology. This is a young field, and there's just some extraordinary people, many of them real true heroes, and Otis has his figure on the pulse of that.

DAVID JOHNSON: Yeah, that's why he's been in some of the right places at the right time, and we'll hear more about that in this segment coming up now.

PATRICK LOEHRER: Now Otis has had a career in many different areas, including ODAC, the NCI, the ACS, now at Hopkins. So let's hear a little bit more about Dr. Brawley's experience at the American Cancer Society and particularly with his experience with the former CEO, John Seffrin.

DAVID JOHNSON: Sounds great.

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OTIS BRAWLEY: John and I had a wonderful run at the American Cancer Society. Got to do a lot of things. Got to testify for the Affordable Care Act. Got to do some of the science to actually argue that the Affordable Care Act would help. And I was fortunate enough to be there long enough to do some of the science to show that the Affordable Care Act is helping.

DAVID JOHNSON: Yeah, I mean actually all of the things you accomplished at the ACS are truly amazing. Let me ask you, just on a personal level, what did you like most about that job, and then what did you like least about that job?

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OTIS BRAWLEY: I like the fact-- there were a lot of things I liked about that job. There were a couple hundred scientists and scientific support people that you got to work with. And I used to always say, I do politics so you can do science. And what I used to like the most, every Wednesday afternoon that I was in town, I would walk around just to watch those people think. I used to joke around and say, I'm just walking around to see who came to work today. But I really enjoyed watching them work and watching them think, and that was fun.

Another fun aspect of the job was people used to call and ask a little bit about the disease that they are a family member would have. And sitting down with them on the phone in those days-- we didn't have Zoom-- and talking to them through their disease. Not necessarily giving them advice on what to do in terms of treatment, but helping them understand the biology of the disease or connecting them with someone who was good in their disease.

And I happen to, by the way, have sent some patients to both of you guys. That was a lot of fun. Then the other thing, of course, was the fact that you could actually influence policy and fix things. I'll never forget sitting across from Terry Branstad, then the governor of Iowa, and convincing him that the right thing to do is to raise the excise tax on tobacco i...

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Oncology, Etc. – On Leadership and Pearls of Life with Dr. Susan Desmond-Hellmann (Part 1)

Part one of this two-part Oncology, Etc. episode features an inside look at the amazing career of Dr. Susan Desmond-Hellmann (spanning from early AIDS research in Kenya and drug development at Genentech, to serving as UCSF Chancellor and CEO of the Bill and Melinda Gates Foundation). Hosted by Drs. Patrick Loehrer (Indiana University) and David Johnson (University of Texas).

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Air Date: 11/04/21

TRANSCRIPT

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DAVE JOHNSON: I'm Dave Johnson. I'm a Professor of Medicine here at UT Southwestern Medical School in Dallas, Texas.

PAT LOEHRER: I'm Pat Loehrer. I'm Director of the Centers of Global Health at Indiana University Melvin and Bren Simon Comprehensive Cancer Center.

DAVE JOHNSON: We have a remarkable guest today, Dr. Susan Desmond-Hellmann. She's like the Wonder Woman of oncology who's done many amazing things during the course of her career. It would take us more than an hour or more just to read off her CV.

But very briefly, Dr. Hellmann is a graduate of the University of Nevada, Reno where she got both her Bachelor and her medical degrees. She received her medical training at the University of California, San Francisco. And then after that, did something really interesting. She went to Uganda for a couple of years and worked at the Ugandan Cancer Institute where-- maybe we can delve into that a little bit later during the course of this discussion to find out what she did while she was there.

After which, she also did a couple of years of private practice and then joined industry, first at Bristol Myers, where she was instrumental in the development of a very important drug for a lot of different diseases-- paclitaxel And then in the mid-90s, she joined this little biotech company called Genentech, first, I think, as a clinical scientist. But over the course of a few years, she rose to the level of president of product development and really was instrumental in developing many drugs, including trastuzumab and bevacizumab.

In fact, I think it was Forbes magazine that named her as one of the world's seven most powerful innovators, which we have to ask her more about that later, about being a powerful innovator. After really a stellar career in the industry, she then went back into academics. She became the chancellor of the University of California, San Francisco, and I believe the first woman to hold that position, if I'm not mistaken.

During her tenure, many remarkable things happened at UCSF, including growth of their campus in the Mission Bay. She was responsible, with a committee put together by the National Academy of Sciences, of producing the report entitled Toward Precision Medicine, Building the Knowledge Network for Biomedical Research and a New Taxonomy of Disease.

In March of 2014, I believe it was, she took yet another position, this time in the world of philanthropy, where she became the chief executive officer of the Bill and Melinda Gates Foundation, a position she held until December of 2019. And that's certainly something we want to ask her about. Dr. Hellmann has many, many accolades. I can't list them all, but she's a member of the Biotech Hall of Fame, the American Academy of Arts and Sciences, the National Academy of Medicine, and she's even received an honorary science degree from Princeton University.

They won't even invite us to the campus, Pats. I'm not sure what it takes to get an honorary degree, but Sue, welcome to Oncology, Etc. And thank you so much for agreeing to this interview.

SUSAN DESMOND-HELLMANN: Well, thank you for having me. I'm really glad to be here and look forward to our conversation.

DAVE JOHNSON: Pat, why don't you ask the first question.

PAT LOEHRER: So Sue, if you could tell us a little bit about yourself from birth until your early career and what shaped your early directions.

SUSAN DESMOND-HELLMANN: Well, I'm actually a California native and grew up in Reno, Nevada, thus the University of Nevada connecti...