Responses to COVID-19 Vaccines Vary in Patients With Hematologic Malignancies
Responses to COVID-19 Vaccines Vary in Patients With Hematologic Malignancies
This article was originally published on Cancer Therapy Advisor
Patients with hematologic malignancies are known to be at risk of severe outcomes from COVID-19, and experts have recommended prioritizing these patients for COVID-19 vaccination.1,2
However, research has suggested that patients with hematologic malignancies may not mount an effective antibody response to vaccination.3
A study recently published in Cancer Cell provides insight into which hematologic malignancies and anticancer treatments confer a greater risk of poor antibody response, as well as which vaccine may be more likely to produce a response in patients with blood cancers.
To continue reading this article on Cancer Therapy Advisor
The Medicine Gap
The Medicine Gap
Many New Zealanders who try to effect change by advocating for help or medicines support from Pharmac or the Government do so at a very vulnerable time in their lives.
They, or their loved ones are often ill or trying to come to terms with a life-threatening or terminal diagnosis. Often, they are lone voices calling for change or help. Always, it is a David versus Goliath battle.
The Medicine Gap is helping to provide a collective voice to the thousands and thousands of New Zealanders who need help to stay well or to stay alive.
It is our hope that every New Zealander understands the medicines predicament we are in and will join our call to provide First World access to modern medicines for New Zealanders.
– The Medicine Gap
Upcoming CLL events
Upcoming CLL events
International Awareness
Leukaemia and Blood Cancer (LBC) NZ – Blood Cancer Forum
CLLAN Horizons Conference
5 -7 November
Pharmac commits to being more transparent
Priority lists for funding applications
On 28 July for the first time Pharmac released its ‘Options for investment list’. These are the priority medications Pharmac would like to fund if they had the budget to do so. They do not provide a ranking so we don’t know where each medication sits on the list. See the list here.
As a Cancer Patient, Will I Need an Extra Dose of a COVID-19 Vaccine?
As a Cancer Patient, Will I Need an Extra Dose of a COVID-19 Vaccine?
This article was originally posted on Patients Power
Individuals who are immunocompromised, including people with cancer, are wondering if they will need an additional dose of a COVID-19 vaccine to increase their level of protection against the coronavirus. The Advisory Committee on Immunization Practices (ACIP), which makes recommendations to the Centers for Disease Control and Prevention, met on July 22 to discuss this issue, among other topics. The meeting was a preliminary step in discussing the safety and effectiveness of additional vaccine doses before any new recommendations can be made.
When a person has cancer, there are two main reasons why they have an increased risk of infection: Either the disease itself or its treatment may cause suppression of the immune system. When this happens, a person may be considered immunocompromised. It is estimated that close to 3% of the U.S. population is immunocompromised, including those with solid tumors and blood cancers, people who have had organ or stem cell transplants, and those being treated with drugs that affect the immune system, including certain chemotherapy medications and corticosteroids.
While research indicates a very strong response to the COVID-19 vaccines in the general population, there is growing evidence that some people who are immunocompromised have a less robust immune response, even after they have been fully vaccinated.
Let’s review a bit. With rare exceptions, it is vital for everyone with cancer to get a COVID-19 vaccination as soon as they can, including those on most active treatments. Many experts at the ACIP meeting reemphasized the importance of vaccinations for people who are immunocompromised and further pointed out the key role of a “circle of protection” surrounding those who are immunocompromised consisting of other vaccinated individuals. It is important that all household members and others you are in close contact with are vaccinated.
CLL and Dermatology
CLL and Dermatology
Overview
More than a quarter of CLL patients experience skin issues. On Thursday, August 12th, at 2 pm PDT/5 pm EDT, join host Michele Nadeem-Baker and two doctors from The Ohio State University Comprehensive Cancer Center – The James: Jennifer Woyach, MD, hematologist/oncologist, and Brittany Dulmage, MD, a dermatologist specializing in oncodermatology, for a discussion about CLL and skin. How do skin concerns factor into CLL treatment decisions? What role can a dermatologist play on a patient’s care team? Join us for the answers to these questions and more.
Attempting to target the tumor microenvironment leads the way to an array of potential targetable pathways in the disease..
According to the researchers, attempting to target the tumor microenvironment leads the way to an array of potential targetable pathways in the disease, including through the use of combination therapy.
A variety of treatments spanning different treatment classes are being studied for use in chronic lymphocytic leukemia (CLL) in an attempt to target the tumor microenvironment environment (TME) of CLL, which attributes to the disease’s genetic complexity. In a recent review, researchers outlined the potential of the approach.
According to the researchers, attempting to target the TME, which is essential for the development, growth, and survival of malignant B-cell clone in CLL, leads the way to an array of potential targetable pathways in the disease, including through the use of combination therapy.
“It is becoming evident that improving clinical responses (residual and progressive disease), overcoming toxicity, infection risk, as well as drug resistance, likely require strategies aimed at reshaping the immunosubversive, pro-tumor TME state,” explained the researchers. “Our improved understanding of the direct and indirect CLL-TME modulations by novel therapeutic agents in recent years provides a unique opportunity to optimize CLL treatment with strategic drug combinations that target multiple CLL-TME interactions to achieve therapeutic synergy while controlling toxicity.”
Combinations include adding venetoclax to ibrutinib, which has showed promise for improving the duration of remissions, as well as adding the PI3K inhibitor duvelisib to venetoclax to improve the sensitivity of CLL cells. The latter is currently being tested in clinical trials.
Venetoclax has also showed promise in combination with anti-CD20 antibodies, with the combination demonstrating in vitro an improvement in the phagocytosis of CLL cells by macrophages while reversing resistance to venetoclax.
“Interestingly, although venetoclax plus anti-CD20 treatment produces impressive clinical responses in clinical trials, a recent retrospective study including real-world data demonstrated comparable efficacy between venetoclax as a single agent and venetoclax plus anti-CD20 combination treatment in high risk relapsed/refractory CLL patients,” wrote the researchers, “Thus, further validating prospective studies are warranted to determine whether the addition of an anti-CD20 antibody to venetoclax is truly necessary.”
On the other hand, adding an anti-CD20 antibody to ibrutinib also seemed to result in faster remissions and lower residual disease but was found to not improve profession-free survival.
This article was originally posted AJMC
Research has also focused on chimeric antigen receptor (CAR) T-cell therapy, as identifying treatment regimens that overcome T-cell dysfunction and improve the efficacy of T-cell-based treatments and immune checkpoint blockade represent some of the biggest challenges in CLL.
Early research has indicated that adding ibrutinib to CAR T-cell function concurrently may enhance CAR T-cell function. In one clinical pilot study, adding concurrent ibrutinib to CD19-targeted CAR T-cell therapy showed strong response rates in patients with relapsed/refractory CLL. The treatment combination also showed lower toxicities than CAR T-cell therapy alone.
Reference
Svanberg R, Janum S, Patten P, Ramsay A, Niemann C. Targeting the tumor microenvironment in chronic lymphocytic leukemia. Haematologica. Published online April 22, 20
Medical specialist says Pharmac 'wish list' is a 'necessity list'
Medical specialist says Pharmac 'wish list' is a 'necessity list'
Health expert discusses Pharmac’s funding option list
Watch the video here. Credits: The AM Show.
For the first time there is transparency with Pharmac.
The released ‘Options for Investment’ list, provided to Newshub, shows 73 medicines yet to be funded. Should the Government bite the bullet and invest in these life saving recommendations?
Former Executive Director of Association of Salaried Medical Specialists and health commentator Ian Powell joined The AM Show on Friday morning.
Exploring Why Venetoclax and Ibrutinib Have Synergy in the CLL Population
Exploring Why Venetoclax and Ibrutinib Have Synergy in the CLL Population
This article was originally posted on Targeted Oncology
William G. Wierda, MD, PhD, D. B. Lane Cancer Research Distinguished Professor, section chief of Chronic Lymphocytic Leukemia, and center medical director in the Department of Leukemia, Division of Cancer Medicine, and executive medical director of The University of Texas MD Anderson Cancer Center, discusses the synergy between ibrutinib (Imbruvica) and venetoclax (Venclexta) in patients with chronic lymphocytic leukemia (CLL).
Ibrutinib, a Bruton’s Kinase inhibitor (BTK), inhibits a molecule that is downstream of the B-cell receptor–signaling pathway, BTK. It was approved for use in patients with relapsed disease first and then as frontline treatment in CLL. Wierda says it is very effective and active, including in patients who have been considered high-risk; these patients are defined as those who harbor 17p deletions or TP53 mutations.
Venetoclax is also a small molecule inhibitor that inhibits BCL-2. When patients’ CLL cells are exposed to venetoclax and BCL-2 is inhibited with this agent, it pushes the cells into apoptosis and causes cell death of the CLL.
Ibrutinib is very effective at managing this disease, according to Wierda. Clinically, it works well in shrinking lymph node size in these patients. Many of those who respond achieve a partial response. This means there is still some measurable disease, usually in the bone marrow or blood. Wierda says venetoclax is highly effective at killing CLL cells and is very potent at killing cells in the blood and bone marrow. However, it’s less active when it comes to shrinking nodal disease.
Higher Overall Response Rates Observed When Adding Ublituximab to Ibrutinib Treatment for CLL
Higher Overall Response Rates Observed When Adding Ublituximab to Ibrutinib Treatment for CLL
This article was originally published on CancerNetwork
The combination of ublituximab plus ibrutinib (Imbruvica) led to a statistically higher overall response rate while maintaining the tolerable safety profile over ibrutinib monotherapy to treat patients with relapsed or refractory high-risk chronic lymphocytic leukemia (CLL).
According to data published in The Lancet Haematology from the phase 3, multicenter, GENUINE (NCT02301156) trial, these findings support the addition of ublituximab to Bruton tyrosine kinase (BTK) inhibitors as treatment for patients with this class of CLL.
“Clinically meaningful improvements in overall response rate, complete response, and MRD negative response were observed and translated into improved progressionfree survival,” wrote the investigators. “These findings indicate the benefit of adding the nextgeneration antiCD20 antibody ublituximab to ibrutinib in patients with relapsed and refractory high-risk chronic lymphocytic leukaemia.”
The overall response rate was 83% of patients in the ublituximab plus ibrutinib group and 65% of patients in the ibrutinib group (P = .020) after a median follow-up of 41.6 months (IQR 36.7–47.3).
While the safety profile consisted mostly of grade 1 or 2 adverse events, neutropenia (19% of patients in the combination group vs 12% in the control group), anemia (8% vs 9%, respectively), and diarrhea (10% vs 5%) were common grade 3 and 4 adverse events among the population of interest.
More, common serious adverse events included pneumonia (10% with ublituximab vs 7% with ibrutinib only), atrial fibrillation (7% vs 2%, respectively), sepsis (7% vs 2%), and febrile neutropenia (5% vs 2%).
Two patients from the ublituximab plus ibrutinib group and 5 patients and from the ibrutinib group died from adverse events. Only 1 death (cardiac arrest) from the ibrutinib group was considered treatment-related.