18th Congress of EHA

Highlights from EHA 2013

Prof Anton Hagenbeek - Universitair Medisch Centrum Utrecht, Heidelberglaan, Netherlands

Dr Hagenbeek, thank you very much for joining us in Stockholm. First of all can you highlight some of the more important clinical developments in the management of blood disorders that have been showcased at this meeting?

Yes, well we had a very exciting press briefing two days ago where we invited the breakthrough abstracts and they were briefly presented in lay language to the press that was there. Some of the highlights there had to do with multiple myeloma, a form of bone marrow cancer, that is a dreadful disease to treat but there are certain exciting new developments. One is in the field of a new small molecule, an immunomodulator. We all know about thalidomide and lenalidomide but this is a third generation, pomalidomide, the names get more complex all the time, I hope I pronounce it correctly. That was an exciting study, a large randomised study from Spain, Dr San Miguel, who added pomalidomide to dexamethasone and without that many side effects he showed that those patients in relapse of multiple myeloma had a significantly better overall survival, that is, of course, the one and only thing that really counts for patients – how long can I live and can I be cured? So that was a breakthrough in the field of multiple myeloma.

Another abstract on that point was just like we have been witnessing of the development in the treatment of non-Hodgkin’s lymphoma, lymph node cancer, by adding rituximab, the well-known antibody that has made a difference. There is now an antibody being explored, again in multiple myeloma, directed against the malignant plasma cells that are the core of multiple myeloma. Dr Lokhorst from Utrecht, representing an international study group, for the first time showed the efficacy of this antibody with no major side effects to reduce the number of plasma cells to really put patients with multiple myeloma in a remission. So that is another step forward, both in the arena of bone marrow cancer, multiple myeloma.

Now you’ve talked about overall survival being the most important factor for patients but also their quality of life during that survival. Can you say something about that?

Well, these patients, as I said, did not really experience any major side effects of the antibody treatment. It’s an outpatient clinic procedure, so they come in, they get the antibody, they go home again. And their quality of life while the disease is going back in its cage is only improving. So it’s a two-hitting sword, that the myeloma is going into remission and the quality of life is improving. So it’s a win-win situation.

So in terms of the future of blood disorders, do you think it’s in safe hands in the next few years, in Europe at least?

In safe hands? The new molecules that are being explored, because that was another exciting contribution by Dr Wyndham Wilson from the National Cancer Institute in Bethesda in the USA, and that is in the general context of the large number of small smart molecules that continuously drip from the pipeline, from the biotech companies, driven by more insight into the origin of these malignant diseases like lymphoma, leukaemia where molecular biologists now gradually, step by step, unravel the signal transduction pathways through which the malignant cell keeps dividing. Subsequently, if they have that insight, they prepare small molecules that block those pathways and the cell doesn’t get any signals anymore and it’s destined to die. That was another major contribution, this time from Dr Wilson, with a small molecule in a tablet and if you take that tablet once a day with no major side effects again, outpatient clinic, lymphoma also goes into remission. The next step, of course, is to combine those small molecules to block similar pathways at the same time because those cancer cells are very smart, if one pathway is blocked they take another route. But molecular biologists in the end will be smarter, they also block those other pathways. So that is really the near future of malignant haematology.

So from a research perspective, quite exciting times ahead.

It is, it is. There are even more molecules dripping from the pipelines than there are patients, so to speak, so it’s also quite a challenge for us as clinical haematologists to change the trial designs, not comparing 300 patients with the new drug versus 300 patients with the best drug so far but making more clever trial designs with smaller subgroups of patients and getting to an answer more rapidly. Because it’s also clear in acute leukaemia, in lymphoma, that we are not dealing with one disease entity because we know now that, for instance, acute myeloid leukaemia consists of thirty, at least thirty, different subtypes based on the genetic abnormalities that you can group now the patients in. So the old fashioned one size fits all, in terms of choosing a treatment, is going to disappear. You’re going to personalise medicine based on the characteristics, the molecular characteristics, of a given tumour and that might differ from patient to patient. So that’s another challenge that also needs refined molecular diagnostics before you make up your mind what the best possible treatment for that patient is. By choosing that we also prevent over-treatment and under-treatment. Today in oncology in general 70% of patients are being bombarded with chemotherapy without any success, it’s only toxicity. Only 30% profit in some way or another and that is something that has to be changed to prevent toxicity and give the patient the appropriate molecule.

Thank you very much indeed.