Currently Viewing:
American Society of Clinical Oncology Annual Meeting
Persephone Trial: Cutting Trastuzumab Duration by Half Safer, Efficacious in HER2-Positive Breast Cancer
May 29, 2018
Remote Monitoring Can Reduce Radiation-Related Symptoms in Head and Neck Cancer
May 30, 2018
Despite USPSTF Recommendations, Lung Screening Rates Low Among Heavy Smokers
May 31, 2018
Currently Reading
Nelarabine With Chemotherapy Boosted Outcomes in Pediatric and YA Patients With T-Cell Cancers
June 01, 2018
Promising Early Phase Results With bb2121 CAR T Treatment in Relapsed Refractory Multiple Myeloma
June 02, 2018
Dr Peter Paul Yu Discusses the Impact of Health Information Technology in Oncology
June 02, 2018
Identifying Rational Immunotherapy Combinations for Glioblastoma: A Progress Report
June 02, 2018
Dr James Lin Chen Outlines Information Needs in Era of Precision Medicine
June 02, 2018
Ellen Miller Sonet Highlights Financial Burdens of Patients With Cancer
June 02, 2018
Utilization Management in Oncology: Current Strategies and a Path Forward
June 02, 2018
Immune Checkpoint Inhibitors Improve Outcomes in Mismatch Repair Deficient CRC, but Can Induce irAEs
June 02, 2018
ZUMA-1: Response to Axi-cel at Three Months Prognostic for Remission in B-cell Lymphoma
June 03, 2018
Cetuximab With Chemoradiation Worse Than Chemoradiation Alone in Older Patients With HNSCC
June 03, 2018
Dr Michael Thompson: The Role of Precision Medicine in the Community Setting
June 03, 2018
Dr Victoria Villaflor Outlines Challenges With Pursuing Precision Medicine
June 03, 2018
Clinical Trials: Sharing the Road With Real-World Evidence
June 04, 2018
Phase 3 TAILORx Results Confirm Chemotherapy Unnecessary in 70% of Women With Early-Stage Breast Cancer
June 04, 2018
KEYNOTE-042 Confirms First-Line Pembrolizumab Superior to Chemotherapy in PD-L1–Low Advanced NSCLC
June 04, 2018
Cemiplimab, in GOG 3016, Looks to Break New Ground for Immunotherapy in Cervical Cancer
June 04, 2018
Nearly Half of Patients With Metastatic CSCC Respond to Cemiplimab, on Fast Track at FDA
June 04, 2018
Opdivo Plus Chemo Boosts Progression-Free Survival 26% Over Chemo Alone in Late-Stage NSCLC
June 04, 2018
Managing Cancer-Related Pain in the Era of the Opioid Crisis
June 06, 2018
Discussing the Cost Burden of Cancer With Patients
June 06, 2018
Study Underscores Value of PROs in Improving Lung Cancer Survival
June 07, 2018

Nelarabine With Chemotherapy Boosted Outcomes in Pediatric and YA Patients With T-Cell Cancers

Surabhi Dangi-Garimella, PhD
A phase 3 study, conducted by the Children’s Oncology Group among children and young adults between ages 1 and 30 diagnosed with T-cell acute lymphoblastic leukemia or T-cell lymphoblastic leukemia, has found a 90% survival rate at 4 years posttreatment initiation—84% of these patients were declared cancer free at that point in their treatment trajectory. Results from this study will be presented at the 2018 American Society of Clinical Oncology Annual Meeting, June 1-5, in Chicago, Illinois.
A phase 3 study, conducted by the Children’s Oncology Group (COG) in 2007, among children and young adults between ages 1 and 30 diagnosed with T-cell acute lymphoblastic leukemia (T-ALL) or T-cell lymphoblastic leukemia (T-LL) has found a 90% survival rate at 4 years posttreatment initiation—84% of these patients were declared cancer free at that point in their treatment trajectory. Results from this study will be presented at the 2018 American Society of Clinical Oncology Annual Meeting, June 1-5, in Chicago, Illinois.

The COG AALL0434 study enrolled 1895 patients during an 8-year period (January 2007- July 2014) to test nelarabine, an antineoplastic agent directed against T cells, in combination with chemotherapy. The trial had 4 arms; all patients received COG augmented Berlin-Frankfurt-Munster or aBFM chemotherapy. Additionally, they were randomized to receive escalating dose methotrexate without leucovorin rescue + pegaspargase (CMTX) or high-dose methotrexate (HDMTX) + leucovorin rescue. Patients with moderate and high risk were randomized to receive, or not receive, six 5-day courses of nelarabine 650 mg/m2/day, complemented with chemotherapy and cranial radiation.

“T-cell ALL is a disease that requires the use of a very intense and complex chemotherapy regimen. Historically, about 80% of people live at least four years after being treated for their disease, but we felt we could and must do better,” lead author Kimberly Dunsmore, MD, professor, Virginia Tech Carilion School of Medicine in Roanoke, said in a press release. “Our trial shows that we could further increase survival rates by about 10%, which is very encouraging.”

For all patients, the overall disease-free survival (DFS) rate was 84.3 +/- 1.1% at 4 years, and overall survival (OS) rate was 90.2 +/- 0.9%. The 4-year DFS rate for T-ALL patients randomized to nelarabine (n = 323) versus no nelarabine (n = 336) was 88.9 +/- 2.2% vs 83.3 +/- 2.5%, (P = .0332).

Among T-ALL patients randomized to CMTX, the 4-year DFS for nelarabine (n = 147) versus no nelarabine (n = 151) was 92.2 +/- 2.8% vs 89.8 +/- 3.0% (P = .3825). For patients randomized to HDMTX, the 4-year DFS was 86.2 +/- 3.2% with nelarabine (n = 176) vs 78.0 +/- 3.7% without nelarabine (n = 185; P = 0.024).

Importantly, there was no advantage of nelarabine treatment for high risk T-LL patients; 4-year DFS was 85.0 +/- 5.6% for nelarabine (n = 60) and it was 89.0 +/- 4.7% for patients who did not receive nelarabine (n = 58; P = .2788).

Overall toxicity and neurotoxicity were acceptable and not significantly different between all 4 arms, the authors concluded.

Future studies are directed to evaluate using nelarabine along with chemotherapy without cranial radiation, to avoid the late side effects associated with radiating the brain, including cognitive changes, learning disabilities, neuroendocrine changes and the development of secondary cancers.

Reference

Dunsmore KP, Winter S, Devidas M, et al. COG AALL0434: A randomized trial testing nelarabine in newly diagnosed t-cell malignancy. J Clin Oncol. 2018;36,(suppl; abstr 10500).

Related Articles

Integrating Genomics into Pediatric Cancer Care
NCHS Report: Rising Survivorship in Pediatric Cancers, Brain Cancer Leading Cause of Death
Persephone Trial: Cutting Trastuzumab Duration by Half Safer, Efficacious in HER2-Positive Breast Cancer
Dr Peter Paul Yu Discusses the Impact of Health Information Technology in Oncology
Identifying Rational Immunotherapy Combinations for Glioblastoma: A Progress Report
 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up