David L. Porter
NEW YORK — As treatment options for acute lymphoblastic leukemia and other B-cell malignancies continue to evolve, it is important for general oncologists to know when and how to apply them in practice, according to David L. Porter, MD, director of blood and marrow transplantation and Jodi Fisher Horowitz professor of leukemia care excellence at University of Pennsylvania Health System.
“The ability to cure ALL was one of the great success stories of the 20th century in oncology,” Porter told HemOnc Today after his presentation at the Chemotherapy Foundation Symposium. “But there are still many patients for whom standard chemotherapy approaches are not effective, or they are too toxic. Now, there are new immune therapies for ALL that are dramatically effective [and] beyond anyone's expectations from even just a few years ago.”
Porter, who gave an update of chimeric antigen receptor (CAR) T-cell therapies, said he felt it was necessary to explain the excitement surrounding the recent FDA approval of tisagenlecleucel T-suspension (Kymriah, Novartis) for the treatment of children and young adults with B-cell ALL.
“It has been dramatically effective when other therapies are completely ineffective, and really should be considered for any patient who meets certain criteria,” Porter said. “Given the potency, I think there should be a lot of interest in referring patients for clinical trials with these therapies, which are being done in a number of settings and hopefully will have the potential to lead to approval in the future, as well.”
Porter said it is important to disseminate proper information in an appropriate way to general and community oncologists to teach them why it is important to consider therapies such as CAR T cells, and to advise them about what possible outcomes might be to help them make educated assessments in their practices.
“Cellular therapy in general is going to be a powerful new field in oncology, and potentially other aspects of medicine, and I think it is here to stay,” he said. “It is unusual to see such a leap forward in terms of technology, and efficacy in oncology, but the results really have been stunning.”
Porter said he anticipates rapid clinical development in the cellular therapy space — especially in ALL and lymphoma.
Additionally, Porter said he expects more research to help understand the right clinical situations in which to apply CAR T cells, as well as to develop newer, safer and more potent approaches.
A key consideration, however, will be toxicities associated with CAR T cells, and the way in which these therapies are administered to patients.
“One of the issues, at least initially, [is CAR T cells] should be given in specialized centers, with treatment teams that have experience and familiarity with them,” he said. “Although it is important for the general oncologist to understand how to apply them, when they work and how they work, the model initially will be very much like a bone marrow transplant model. Bone marrow transplants are not done in every office around the country. They’re done in specialized centers with unique experience. And certainly, in the form that CAR T cells are in now, that's going to be the model in large part because of the very unique toxicities that develop. With that said, the community oncologist is going to be referring patients for this therapy and really does need to understand when it is appropriate.” – by Ryan McDonald
Porter DL. Harnessing the Immune System to Combat ALL. Presented at: Chemotherapy Foundation Symposium; Nov. 8-10, 2017; New York.
Disclosures: Porter reports intellectual property interests with Novartis.