ASH in 30 Seconds
Farewell from Atlanta
Hello, it’s Angus here. My parting thoughts as I travel home from Atlanta:
Aside from a few last-minute stragglers, ASH is empty. People started clearing out yesterday evening and when I arrived at the Covid-19 testing center this morning, an employee looked up and said, “We got a live one!”
On the last day of ASH, various attendees told me the general themes and trends of this year’s conference didn’t feel too different from previous years. New combinatorial therapies, bispecific antibodies, and CAR-T cell therapy are still hot topics. But folks are just beginning to set their eyes beyond the most promising therapies of yesteryear.
“Like what’s next after CAR-T,” said Adam Sperling, a medical oncologist at Dana-Farber Cancer Institute. “Most patients, pretty much all of them, still relapse after CAR-T therapy,” he pointed out. So research is shifting to new cell therapy targets or entirely new types of drugs that might make it harder for cancer cells to escape.
Myeloma screening was a big topic this year, particularly screening for individuals with certain precancerous conditions like smoldering myeloma or certain monoclonal proteins called MGUS. A 75,000-person study from the University of Iceland showed early results that suggest doing this type of screening may help find myeloma early and possibly improve outcomes through early intervention.
Irene Ghobrial’s lab at Dana-Farber also had data showing that mass spectrometry and artificial intelligence may improve the detection of these conditions and help identify individuals at higher risk for myeloma.
“Everyone wants to know what their risk of developing cancer is,” Ghobrial said. “And empower themselves to prevent and protect themselves from cancer.”
And from Cambridge, Mass.
Hello! Adam, here. I have to admit, I felt some FOMO over the first in-person ASH in two years. On Twitter, the #ASH21 stream was filled with pics of people enjoying their hematology reunions. Even with masks, the smiles and good feelings came through.
Let’s hope Omicron does not.
Tuesday is ASH’s wind-down day, but there’s still news to report, although it’s disappointing and puzzling. In a large Phase 3 study, Novartis’ bespoke CAR-T therapy Kymriah showed no benefit over a standard stem cell transplant when used to treat patients with large B-cell lymphoma relapsed after initial therapy.
The negative Kymriah trial, called BELINDA, puts Novartis in a tough spot because two nearly identical studies conducted by its competitors Gilead Sciences and Bristol Myers Squibb for their respective CAR-T treatments — Yescarta and Breyanzi — read out positive and will likely lead to expanded use in earlier lines of treatment for lymphoma.
It’s not entirely clear why Novartis’s CAR-T failed to prove a benefit for patients while those from Gilead and Bristol did. One possible explanation: issues with Novartis’ CAR-T manufacturing process. It took the pharma giant a median of 52 days to make Kymriah for each patient. Gilead’s Yescarta manufacturing time, by contrast, took a median of 27 days.
Kymriah’s future may not be cooked, even with the negative BELINDA results. Writing in the New England Journal of Medicine on Tuesday, scientists with the National Cancer Institute pointed to some differences in the designs of the ZUMA-7 and BELINDA trials, and the patients enrolled, which may have contributed to the disparate results.
“Concluding that [Yescarta] must be superior to [Kymriah] is the wrong inference from the data,” the scientists wrote.
For patients with B-cell lymphoma, the good news that emerged from this year’s ASH meeting is that personalized CAR-T treatments offer the potential for deep and durable remissions exceeding what’s typically seen with stem cell transplants. But physicians are likely to continue debating which lymphoma patients are most likely to benefit from a change in treatment practice, and which CAR-T offers the best chance at a lasting remission.
Wait, there’s more!
If you haven’t yet tired of ASH, join Angus and Adam on Wednesday at 1 p.m. ET for a one-hour virtual recap of the ASH annual meeting.
Our guests will be Jane Winter, professor of medicine, division of hematology/oncology at Northwestern University’s Feinberg School of Medicine; and Mikkael Sekeres, chief, division of hematology, Sylvester Comprehensive Cancer Center, University of Miami Health System.
You can register for the STAT virtual event here.
And with that, we’ll put another ASH in 30 Seconds newsletter to bed. Thanks so much for your readership. We look forward to reconvening for ASH22 in New Orleans! Until then, goodbye!