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In recent years, the treatment of hematological tumors has been changing with each passing day, and many advances have been made in theory and clinical practice.
In order to further improve the level of diagnosis and treatment of lymphoma in my country, the CSCO Anti-Lymphoma Alliance Tour-Tianjin Station Conference was successfully held in Tianjin on March 27, 2021.
This conference is based on the clinic, focusing on the frontier progress of lymphoma, and discussing the diagnosis and treatment of lymphoma in depth.
On this occasion, Yimaitong specially invited Professor Zou Dehui, the executive chairman of the conference, from the Hospital of Hematology, Chinese Academy of Medical Sciences, to interview and share the progress and prospects of the treatment of B-cell lymphoma.
Professor Zou Dehui Chief Physician, Master's and Master's Tutor, Assistant Director, Lymphoma Clinic, Hospital of Hematology, Chinese Academy of Medical Sciences (Institute of Hematology, Chinese Academy of Medical Sciences), Member of Lymphoma Professional Committee of Chinese Anti-Cancer Association Lymphoma Professional Committee of Hematological Oncology Committee of Chinese Anti-Cancer Association Deputy Leader of the Academic Group, Member of the Standing Committee of the Hematology Branch of the Chinese Association of Geriatrics, Member of the Lymph and Hematology Professional Committee of the Chinese Society of Geriatric Oncology, Deputy Chairman of the Lymphoma Professional Committee of Tianjin Anti-Cancer Association, Deputy Director, Tianjin Anti-Cancer Association, Oncology and Critical Care Medicine Professional Committee, China Multiple Myeloma Research Alliance member "Chinese Journal of Hematology" newsletter Yi Maitong: At present, my country has made many progress in the treatment of lymphoma.
Could you please introduce the value of targeted therapy for the treatment of lymphoma patients? Professor Zou Dehui's targeted therapy can be divided into broad and narrow sense.
Broadly targeted therapy of lymphoma (including monoclonal antibodies, small molecule targeted drugs, immune checkpoint inhibitors, etc.
) has made many progress in the field of lymphoma, enriching the treatment of lymphoma, and significantly improving lymphoma patients Efficacy.
The following is an introduction to the development of generalized targeted therapy for lymphoma.
First, in the treatment of macromolecular drugs that target tumor cell surface antigens or receptors, the development of monoclonal antibodies, bispecific antibodies, and antibody-drug conjugates (ADC) has enriched the types of antibody drugs.
Secondly, in the treatment of small molecule drugs that target intracellular signaling pathways and microenvironment, such as BTK inhibitors, their single drugs are used in chronic lymphocytic leukemia, mantle cell lymphoma, Waldenstrom's macroglobulinemia and other diseases.
A significant effect.
However, the current small molecule drugs are not effective for all types of lymphoma.
For example, the most common diffuse large B-cell lymphoma (DLBCL) involves many signaling pathways, but a single target is specific to certain pathways.
Small molecule targeted drugs may be difficult to completely overcome the occurrence and development of DLBCL and the occurrence of drug resistance.
In addition, targeting PD-1 and PD-L1, including immune checkpoint inhibitors and cellular immunotherapy targeting CD47 that are currently being developed are also under development and research.
With the improvement of the understanding of the nature of the disease and the application of targeted drugs, certain lymphomas have been able to achieve "Chemo-free" (no chemotherapy) treatment mode.
However, it should be noted that compared with traditional chemotherapy regimens, targeted therapy is not without toxicity or low toxicity.
Various drugs have different adverse reaction profiles.
Therefore, do not ignore the prevention, monitoring and management of toxic reactions in the application.
In which type of disease, which drugs are more effective, single-drug or combined drugs are better, and whether the toxic and side effects of different drugs are superimposed and other issues need to be closely monitored.
Yimaitong: Currently, bispecific antibodies have become a hot spot in lymphoma research.
Could you please talk about the research progress of bispecific antibodies in the field of lymphoma treatment? Professor Dehui Zou's bispecific antibody is an antibody that targets cell surface antigens.
Compared with monoclonal antibodies, its therapeutic effect is better.
The first relatively successful bispecific antibody, belintolumab targeting CD19 and CD3, has achieved significant efficacy in acute lymphoblastic leukemia, and it has also been used in B-cell non-Hodgkin's lymphoma.
However, there are some limitations in terms of convenience (a course of treatment requires continuous infusion for 28 days).
The new generation of bispecific antibodies (such as the bispecific antibodies targeting CD3 and CD20) have been restructured to prolong the half-life and action time, and at the same time improve the convenience of application.
At present, various phases of clinical research have been carried out, which is worthy of everyone look forward to.Yimaitong: In addition to targeted therapy, CAR-T related research is also in full swing at home and abroad.
At present, CAR-T has become one of the treatment options for relapsed/refractory DLBCL and has attracted much attention.
Could you please introduce the research progress of CAR-T in the treatment of DLBCL? Professor Zou Dehui In recent years, Chimeric Antigen Receptor (CAR) T-cell therapy has brought revolutionary progress in the treatment of lymphoma.
In terms of clinical research, China and developed countries can almost reach a par with each other.
For patients with relapsed/refractory DLBCL (especially those who have received ≥2 line treatment in the past), CAR-T cell therapy is currently a more effective treatment method, which can significantly improve the efficacy compared with traditional salvage treatments.
A number of clinical studies have shown that CAR-T cell therapy can achieve remission of up to 60% to 80% of end-line treatment patients, and about 40% to 50% of patients can achieve complete remission (CR).
After long-term follow-up, among patients who obtained CR and maintained CR status 6 months after CAR-T treatment, nearly 80% of patients can maintain long-term remission, that is to say, 30% to 40% of patients (even if Multiline relapse/refractory patients) can be cured by CAR-T cell therapy.
Yimaitong: Which is better for CAR-T cell therapy and bispecific antibody therapy for lymphoma? Professor Dehui Zou bispecific antibody and CAR-T cell therapy have their own advantages and disadvantages.
Compared with CAR-T cell therapy, bispecific antibodies have a lower incidence of cytokine release syndrome (CRS) and neurotoxicity.
And after the bispecific antibody is on the market, the drug can be obtained at any time, which is more convenient.
CAR-T cell therapy is an individualized treatment.
From screening to apheresis, to preparation of CAR-T cells, to infusion of patients, it usually takes nearly a month.
Some patients may develop disease progression during this period.
Lost the opportunity for treatment.
However, CAR-T cell therapy is a living cell treatment method.
CAR-T cells can continuously expand in the body.
Compared with bispecific antibodies, CAR-T cells can affect the extranodal, medullary mass or central nervous system.
Strong penetrating power. At the same time, CAR-T cells have a stronger killing effect on lymphomas with relatively large tumor burden.
Therefore, CAR-T cell therapy and bispecific antibodies are not a substitute relationship, but a complementary relationship.
Yimaitong: What are your expectations or prospects for the treatment of lymphoma patients in the future? Professor Zou Dehui must first of all continue to study the pathogenesis and molecular basis of various types of lymphoma.
On the one hand, it can help the precise diagnosis of lymphoma.
On the other hand, it can deeply understand the biological characteristics of various subtypes of lymphoma.
Acting on the development of different target drugs.
Secondly, after deepening the understanding and precise diagnosis of various types of lymphoma, based on the characteristics of various lymphoma subtypes, rational application of existing treatment drugs, or combined application with new drugs, will improve the curative effect of lymphoma patients and improve the survival of lymphoma patients Period, and ultimately benefit the patient.
Poke "read the original text" and we will make progress together
In order to further improve the level of diagnosis and treatment of lymphoma in my country, the CSCO Anti-Lymphoma Alliance Tour-Tianjin Station Conference was successfully held in Tianjin on March 27, 2021.
This conference is based on the clinic, focusing on the frontier progress of lymphoma, and discussing the diagnosis and treatment of lymphoma in depth.
On this occasion, Yimaitong specially invited Professor Zou Dehui, the executive chairman of the conference, from the Hospital of Hematology, Chinese Academy of Medical Sciences, to interview and share the progress and prospects of the treatment of B-cell lymphoma.
Professor Zou Dehui Chief Physician, Master's and Master's Tutor, Assistant Director, Lymphoma Clinic, Hospital of Hematology, Chinese Academy of Medical Sciences (Institute of Hematology, Chinese Academy of Medical Sciences), Member of Lymphoma Professional Committee of Chinese Anti-Cancer Association Lymphoma Professional Committee of Hematological Oncology Committee of Chinese Anti-Cancer Association Deputy Leader of the Academic Group, Member of the Standing Committee of the Hematology Branch of the Chinese Association of Geriatrics, Member of the Lymph and Hematology Professional Committee of the Chinese Society of Geriatric Oncology, Deputy Chairman of the Lymphoma Professional Committee of Tianjin Anti-Cancer Association, Deputy Director, Tianjin Anti-Cancer Association, Oncology and Critical Care Medicine Professional Committee, China Multiple Myeloma Research Alliance member "Chinese Journal of Hematology" newsletter Yi Maitong: At present, my country has made many progress in the treatment of lymphoma.
Could you please introduce the value of targeted therapy for the treatment of lymphoma patients? Professor Zou Dehui's targeted therapy can be divided into broad and narrow sense.
Broadly targeted therapy of lymphoma (including monoclonal antibodies, small molecule targeted drugs, immune checkpoint inhibitors, etc.
) has made many progress in the field of lymphoma, enriching the treatment of lymphoma, and significantly improving lymphoma patients Efficacy.
The following is an introduction to the development of generalized targeted therapy for lymphoma.
First, in the treatment of macromolecular drugs that target tumor cell surface antigens or receptors, the development of monoclonal antibodies, bispecific antibodies, and antibody-drug conjugates (ADC) has enriched the types of antibody drugs.
Secondly, in the treatment of small molecule drugs that target intracellular signaling pathways and microenvironment, such as BTK inhibitors, their single drugs are used in chronic lymphocytic leukemia, mantle cell lymphoma, Waldenstrom's macroglobulinemia and other diseases.
A significant effect.
However, the current small molecule drugs are not effective for all types of lymphoma.
For example, the most common diffuse large B-cell lymphoma (DLBCL) involves many signaling pathways, but a single target is specific to certain pathways.
Small molecule targeted drugs may be difficult to completely overcome the occurrence and development of DLBCL and the occurrence of drug resistance.
In addition, targeting PD-1 and PD-L1, including immune checkpoint inhibitors and cellular immunotherapy targeting CD47 that are currently being developed are also under development and research.
With the improvement of the understanding of the nature of the disease and the application of targeted drugs, certain lymphomas have been able to achieve "Chemo-free" (no chemotherapy) treatment mode.
However, it should be noted that compared with traditional chemotherapy regimens, targeted therapy is not without toxicity or low toxicity.
Various drugs have different adverse reaction profiles.
Therefore, do not ignore the prevention, monitoring and management of toxic reactions in the application.
In which type of disease, which drugs are more effective, single-drug or combined drugs are better, and whether the toxic and side effects of different drugs are superimposed and other issues need to be closely monitored.
Yimaitong: Currently, bispecific antibodies have become a hot spot in lymphoma research.
Could you please talk about the research progress of bispecific antibodies in the field of lymphoma treatment? Professor Dehui Zou's bispecific antibody is an antibody that targets cell surface antigens.
Compared with monoclonal antibodies, its therapeutic effect is better.
The first relatively successful bispecific antibody, belintolumab targeting CD19 and CD3, has achieved significant efficacy in acute lymphoblastic leukemia, and it has also been used in B-cell non-Hodgkin's lymphoma.
However, there are some limitations in terms of convenience (a course of treatment requires continuous infusion for 28 days).
The new generation of bispecific antibodies (such as the bispecific antibodies targeting CD3 and CD20) have been restructured to prolong the half-life and action time, and at the same time improve the convenience of application.
At present, various phases of clinical research have been carried out, which is worthy of everyone look forward to.Yimaitong: In addition to targeted therapy, CAR-T related research is also in full swing at home and abroad.
At present, CAR-T has become one of the treatment options for relapsed/refractory DLBCL and has attracted much attention.
Could you please introduce the research progress of CAR-T in the treatment of DLBCL? Professor Zou Dehui In recent years, Chimeric Antigen Receptor (CAR) T-cell therapy has brought revolutionary progress in the treatment of lymphoma.
In terms of clinical research, China and developed countries can almost reach a par with each other.
For patients with relapsed/refractory DLBCL (especially those who have received ≥2 line treatment in the past), CAR-T cell therapy is currently a more effective treatment method, which can significantly improve the efficacy compared with traditional salvage treatments.
A number of clinical studies have shown that CAR-T cell therapy can achieve remission of up to 60% to 80% of end-line treatment patients, and about 40% to 50% of patients can achieve complete remission (CR).
After long-term follow-up, among patients who obtained CR and maintained CR status 6 months after CAR-T treatment, nearly 80% of patients can maintain long-term remission, that is to say, 30% to 40% of patients (even if Multiline relapse/refractory patients) can be cured by CAR-T cell therapy.
Yimaitong: Which is better for CAR-T cell therapy and bispecific antibody therapy for lymphoma? Professor Dehui Zou bispecific antibody and CAR-T cell therapy have their own advantages and disadvantages.
Compared with CAR-T cell therapy, bispecific antibodies have a lower incidence of cytokine release syndrome (CRS) and neurotoxicity.
And after the bispecific antibody is on the market, the drug can be obtained at any time, which is more convenient.
CAR-T cell therapy is an individualized treatment.
From screening to apheresis, to preparation of CAR-T cells, to infusion of patients, it usually takes nearly a month.
Some patients may develop disease progression during this period.
Lost the opportunity for treatment.
However, CAR-T cell therapy is a living cell treatment method.
CAR-T cells can continuously expand in the body.
Compared with bispecific antibodies, CAR-T cells can affect the extranodal, medullary mass or central nervous system.
Strong penetrating power. At the same time, CAR-T cells have a stronger killing effect on lymphomas with relatively large tumor burden.
Therefore, CAR-T cell therapy and bispecific antibodies are not a substitute relationship, but a complementary relationship.
Yimaitong: What are your expectations or prospects for the treatment of lymphoma patients in the future? Professor Zou Dehui must first of all continue to study the pathogenesis and molecular basis of various types of lymphoma.
On the one hand, it can help the precise diagnosis of lymphoma.
On the other hand, it can deeply understand the biological characteristics of various subtypes of lymphoma.
Acting on the development of different target drugs.
Secondly, after deepening the understanding and precise diagnosis of various types of lymphoma, based on the characteristics of various lymphoma subtypes, rational application of existing treatment drugs, or combined application with new drugs, will improve the curative effect of lymphoma patients and improve the survival of lymphoma patients Period, and ultimately benefit the patient.
Poke "read the original text" and we will make progress together
