Insights Into the Evolving Landscape of Hematology Treatment

Tim Mok, PharmD, BCOP, BCPS, hematology/oncology pharmacy research analyst and assistant clinical professor at UCFS School of Pharmacy, discusses the evolving treatment landscape in hematology, offering patients with hematologic cancers better access to treatment and improved response rates to therapies, strengthening their overall quality-of-life.

Pharmacy Times: Can you provide an overview of the most influential abstracts discussed in your presentation and how they represent a shift in hematology practice and research?

Tim Mok: There are 2 that comes to mind. I think the first one is the APOLLO study [NCT01960348], which looked at high risk patients [with ancestry-specific variation in the apolipoprotein L1 gene (APOL1)]. This is a fantastic one, one that we've been trying to answer on which therapy to give these high-risk patients for quite a while. The second one is HD21 [trial], which is looking at [patients with] advanced stage Hodgkin lymphoma, and whether we can use the BrECADD [regimen of brentuximab vedotin (Adectris; Seagen, Inc), etoposide (Etopophos; Bristol-Myers Squibb Company), cyclophosphamide (Cytoxan; Baxter Healthcare Corporation), doxorubicin (Lipodox; Sun Pharmaceutical Industries Ltd), dacarbazine (DTIC-Dome; Hikma Pharmaceuticals USA Inc), dexamethasone (Decadron; Pfizer CentreOne] vs the BEACOPP [intensified regimen of bleomycin (Bleo 15k; Ciple, Ltd), etoposide, doxorubicin, cyclophosphamide, vincristine (Oncovin; Pfizer), procarbazine (Matulane; Leadiant Biosciences), prednisone (Rayos; Horizon Pharma)].

The HD21 trial looked at advanced stage Hodgkin lymphoma patients, and whether the BrECADD regimen could replace the BEACOPP intensified regimen. Image Credit: © DreamPointArt - stock.adobe.com

Pharmacy Times: What are some of the most innovative therapies highlighted in these abstracts, and how are they expected to impact patient care?

Tim Mok: So, in the APOLLO study, they use idarubicin (Idamycin; Pfizer) in high-risk APL patients. Typically, in this patient population, we are either doing an ATRA [all-trans retinoic acid (Tretinoin; Bausch Health Companies Inc)] and ATO [arsenic trioxide (Trisenox; Teva Pharmaceutical Industries Ltd)] regimen, along with this very convoluted maintenance with 6-MP and methotrexate (Rheumatrex; DAVA Pharmaceuticals, Inc) that nobody really likes. Whereas Apollo doesn't have any of that. Instead, it uses 2 doses of idarubicin.

Pharmacy Times: Can you discuss some of the key clinical trial results and how they address existing gaps or challenges in the treatment of hematological disorders?

Tim Mok: Yeah, I think what this allows us to do is showing that in the Apollo study, although it had to be stopped due to COVID-19, and enrollments in this trial and the drug expiring early, it gave us a lot of hope that this could actually increase overall survival. In the trial, they saw a numeric increase in overall survival by about 10% or 11%. However, it was not statistically significant, but I'm hoping that in if it were to be able to run through all the way they would actually show a difference.

Pharmacy Times: What are some of the most innovative therapies highlighted in these abstracts, and how are they expected to impact patient care?

Tim Mok: In the APOLLO study, although it had to be stopped due to COVID-19, and enrollments in this trial and the drug expiring early, it gave us a lot of hope that this could actually increase overall survival. In the trial, they saw a numeric increase in overall survival by about 10% or 11%. However, it was not statistically significant, but I'm hoping that if it were to be able to run through all the way, they would actually show a difference. I think right now, because the trial was stopped early, there's a lot of clinical questions on whether the trial can be implemented. However, this study actually gives a lot of operational advantages. One is that in consolidation of cycle 1, we no longer have to hospitalize the patient during the whole time. Instead, we can give them outpatient arsenic on Monday through Fridays. And this is especially true for the hospital systems that don't open on weekends. So, the patient can actually be discharged to go home and get the therapy, outpatient. Saving not only risks of infection, things that you just typically have risks for in the hospital, but also it drastically decreases on the hospital operation costs for these patients.

Pharmacy Times: How do the findings aim to improve patient outcomes, particularly in terms of survival rates and quality of life?

Tim Mok: Yeah, as noted before, we're hoping that there will be a statistically different overall survival benefit. But we also know that with these patients, there's a high rate of cure, as long as we get them through the first 30 days. So, we're likely going to see very high cure rates with this APOLLO trial no matter what you do. Secondly, with [sic], you can now be discharged out of the hospital for health systems that aren't open on the weekends, in outpatient clinics are not open on weekends. So, they can go home, enjoy their life, be with their family and not be in the hospital with beeping noises and be able to sleep well.

Pharmacy Times: How can patients be better informed and involved in the decision-making process regarding new treatment options emerging from recent research?

Tim Mok: Yeah, I think there's a lot of advocacy that can go on. Of course, in APL [acute promyelocytic leukemia], there's a lot of discussions with the physician sometimes. Because there are no one right answer it depending on where you're going to for your treatment. They already have like a standard or preferred therapy. But understanding what other options are out there can be a great starting point for discussion. And making sure that all of these therapies would eventually not harm you financially when you go home with that bill, because you're going to get cured with APL, we know that, but we don't want to saddle you with financial burden that you can't handle. So, I think the APOLLO study is a great one that can minimize all of that. I think we are steadily progressing along hematology; we're seeing things that we haven't seen just years ago, cure rates, we're seeing novel therapies that are coming out. It's a fine balance between how much of a positive outcome we want, versus how much resources does it cost our system—that balance continues to waver. And I think what I love about [Oncology Pharmacists Connect] is being able to speak freely about what will work, what will not work, what presents as challenges, but then coming together to figure out what will be the best move forward for our patients.