Steven T. Rosen, MD, Irell & Manella Cancer Center Director’s Distinguished Chair, Morgan & Helen Chu Director’s Chair of the Beckman Research Institute, provost and chief scientific officer, director of the Comprehensive Cancer Center, Beckman Research Institute, and Irell & Manella Graduate School of Biological Sciences, and professor in the Department of Hematology and Hematopoietic Cell Transplantation, at City of Hope, discusses the emergence of novel therapies and the incorporation of immuno-oncology (IO) drugs in hematologic malignancies.
Historically, the treatment of patients with chronic lymphocytic leukemia consisted of a combination of fludarabine, cyclophosphamide, and rituximab (Rituxan) or bendamustine with rituximab. The field has since progressed to the use of BTK inhibitors, such as ibrutinib (Imbruvica) or acalabrutinib (Calquence) with rituximab or with the BCL-2 inhibitor venetoclax (Venclexta), says Rosen.
In some instances, trials evaluating only oral agents, such as a BCL-2 inhibitor and ibrutinib, have shown equivalent results to historical therapies. In multiple myeloma, current frontline therapy is completely biologic, says Rosen. Most commonly, first-line treatment consists of a proteasome inhibitor combined with an immunomodulatory drug and a steroid. Results with those agents are equivalent to or have improved upon what had historically been seen with chemotherapy, concludes Rosen.