VIDEO: Latest treatment options for ALL

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ALL is a wonderful field to be in. We've seen a lot of advances over the last few years and we're looking forward to more advances in the coming years. The major advance is that, while conventional chemotherapy represents still a core treatment option for patients with ALL, we now have immunotherapy and targeted therapies available for both the relapse setting, and those agents are also being developed for treatment in the upfront setting.

So, for the ALL, we have two approved antibody therapies inotuzumab ozogamicin [Besponsa, Pfizer], which is an antibody-drug conjugate targeting CD22, and blinatumomab [Blincyto, Amgen], which is a bispecific T-cell engager that targets CD19 and CD3. So, both these drugs are approved for relapsed ALL. Inotuzumab has certain advantages in terms of being a weekly infusion and benefiting patients with both high and low tumor burden, whereas blinatumomab has particular strength in patients with minimal residual disease. They have different side effect profiles and various challenges, but the bottom line is these drugs are more effective and less toxic than conventional chemotherapy for relapse disease.

And that fact — the fact that they're tolerated and effective in the relapse setting — is really leading to their development as drugs to be integrated into upfront therapy in various scenarios for various treatment populations. There is now randomized data, the ECOG 1910 study which was presented at our annual meeting last year, demonstrating that blinatumomab as a consolidation agent integrated into a chemotherapy-based consolidation improves outcomes for adults with ALL.

That's been really an exciting treatment advance and there are multiple ongoing studies looking at bringing both InO and Blina into upfront treatment protocols for both younger and older patients. The other exciting advances, including the development of cellular therapy are [chimeric antigen receptor (CAR)] T cell for relapsed ALL. There are two approved products, the Novartis product, tisagenlecleucel [Kymriah, Novartis], as well as axicabtagene [Yescarta, Kite Pharma/Gilead Sciences], another product approved for relapsed ALL. These are really wonderful options for the subset of patients through relapse, and we are looking forward to further advances and new CAR T-cell projects in the future that may be even better tolerated and more durable in terms of their responses.