Immunotherapy

Immunotherapy
The National Comprehensive Cancer Network’s first guideline for the management of side effects from immunotherapy recognizes “a new spectrum of adverse events” in patients who are receiving immune checkpoint inhibitor therapy, said John A. Thompson, MD.
New results from the phase 3 QuANTUM-R trial showed that quizartinib, an oral, selective FLT3 inhibitor, significantly extended overall survival compared with chemotherapy in patients with relapsed/refractory acute myeloid leukemia (AML) and the FLT3-ITD mutation.

The National Comprehensive Cancer Network’s first guideline for the management of side effects from immunotherapy recognizes “a new spectrum of adverse events” in patients who are receiving immune checkpoint inhibitor therapy, said John A. Thompson, MD.

Chimeric antigen receptor (CAR) T-cell therapy has had excellent results in late-stage leukemia and varying degrees of success in some other hematologic cancers, but thus far, solid tumors have not responded to this therapy.

Among the 84 patients, 7 had partial responses with the combination of atezolizumab (Tecentriq) and cobimetinib (Cotellic). The median duration of response was 14.3 months.

The combination cohort consisted of 119 patients who received nivolumab 3 mg/kg plus ipilimumab 1 mg/kg every 3 weeks for 4 doses followed by nivolu­mab 3 mg/kg every 2 weeks. The median follow-up was 13.4 months.

“We find that T-cells with highly activated glycolysis pathways ended up performing worse when we tried to make them into CAR T-Cells. Substituting and supplementing heavily with fatty acids did seem to improve this a little,” said David M. Barrett, MD, PhD, at the 2018 American Association for Cancer Research annual meeting.

The FDA granted accelerated approval to nivolumab based on a notable clinical benefit in a subset of patients who progressed after receiving the standard first-line chemotherapy with fluoropyrimidine, oxaliplatin, and irinotecan.

“The main rationale from the cytotoxic era is to increase efficacy by combining agents that have different mechanisms and nonoverlapping toxicities. The question is whether we can replace nonspecific cytotoxic agents with a specific, more effective immunotherapeutic,” said Donna Przepiorka, MD, PhD, at ASH 2017.

As the number of patients receiving immune checkpoint blockade grows, the combination of radiation and immunotherapy has become increasingly relevant, particularly in the palliative care setting, where radiation therapy is used to treat painful lesions or brain metastases.

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