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ASH 2020: Day 4 Update and Final Wrap-Up
Dec. 8th was the final day of ASH 2020, the American Society of Hematology Annual Meeting and Exposition.
And the big news is that there was no big news today. There was no CLL research presented today.
The last day is when the prestigious late-breaking abstracts (LBA) and for years CLL had grabbed the lion’s share of the final spotlight. Not only with LBA, but with the plenary session and with CLL news dominating the press briefing and newscasts.
But not this year. CLL has broken down barriers with targeted therapies, precision diagnostics, and most importantly, prolonged patient survival. The biology was cracked wide open and we revolutionized care – almost a decade ago.
Coincidently just when CLL Society started reporting from ASH.
Now the changes are incremental. Evolutionary, not revolutionary, but still important. We are not leaving empty-handed, we are leaving with a lot of treats and the promise of much more to come.
Here is some of what I am taking away from ASH 2020.
We are recognizing that, while the progress has been enormous, there is still much to be done.
We heard some compelling data on new generations of targeted drugs that are better tolerated, may be safer, and easier to use because they have fewer interactions with other drugs and foods, and in some cases, are more effective. Examples include experimental reversible BTKis that are active when CLL has stopped responding to the approved medications and a new PI3Ki with an improved safety profile that causes less colitis and pneumonitis than the approved molecules.
We read several studies where MRD (measurable residual disease) testing is being increasingly recognized for the powerful predictive tool that, in some trials now, is guiding therapy.
We reviewed dozens of combinations of experimental and approved novel agents, administered together or sequentially, in this order or that, with amazing results. 100% ORR (overall response rates) were not uncommon. Progressions were rare in the majority of patients who reached uMRD (undetectable measurable residual disease).
We are looking at deeper ways to measure MRD and are starting to assess how important that is.
We had more research on predicting whose disease will be more aggressive, who is at higher risk for Richter’s Transformation (RT), who will respond to a particular drug and who won’t, and maybe even what can be done about it.
We learned that there is life after progression. Venetoclax in particular seems to work again when given a second chance.
We learned that CAR-T cells should soon have an important place in treating CLL. Toxicities are being dampened and better managed, and many patients are having durable responses.
And we even heard that 2/3 patients with RT responded to a “fresh”, locally made, never frozen CAR-T product.
We learned of so many promising new experimental drugs which still have only numbers and no names yet are jumping from positive mouse trials to early human trials, forcing us to learn more acronyms as we study new cellular pathways that exploit our cancer’s addictions and weaknesses.
It wasn’t all good news.
We also learned from real-world data that when a blood cancer patient meets COVID-19, it is not a pretty picture, with severe disease being too common and mortality rates high. We learned that our response to the new shingles vaccine is muted and is worse if on a BTKi.
We were reminded, with strong data, that we remain at higher risk for infections and second cancers.
We learned that too many doctors are still not doing proper testing on their CLL patients and that too many are still using CIT (chemo-immuno-therapy) when it won’t work. That is why CLL Society pushes our Test Before Treat™ and Expert Access Program™ to empower patients to get the testing they need and a free expert second opinion.
All the best data and research amount to naught if it’s not being properly deployed.
We also had another year in which ASH (unlike ASCO or EHA or iwCLL or ERIC) didn’t open its arms to patients or advocates and provided no discounted entry fees or special services and sessions. Shame on them!
But we did learn we can do all of this virtually. Less fun! No hugs. No free wine or food, but it works and in some ways, it was better. No crowds, no jacked-up hotel prices, and UBER rates.
And we saw with remarkable consistency, and this is a big change over the last decade, patients are being thanked by the researchers for their participation in clinical trials, and not only patients but their families and their caregivers, as well.
Thanks for following me for these intense days of ASH 2020. It’s not over, but it will slow down.
Expect 100s of ZOOM interviews, videos, and written reports from this most important hematology meeting of the year over the next 12 months.
Stay safe. Stay strong. We are all in this together
Brian Koffman, MD