Kerry A. Rogers, MD:
Hi. I'm Kerry Rogers. I'm an associate professor in the Division of Hematology at The Ohio State University, and I’m really excited to talk to you about the updates from the European Hematology Association meeting.
Were there any updates for the treatment of Richter’s Syndrome?
Kerry A. Rogers, MD:
So for anyone who’s not aware of what Richter’s syndrome is, that is a more aggressive lymphoma in someone that has CLL. The one we’re talking about here and that we think about the most often is actually a second lymphoma that’s Diffuse Large B-Cell Lymphoma. So there are people who get Hodgkin’s lymphomas as Richter’s, but that’s not what we’re going to talk about right now. And it’s treated very differently. So Diffuse Large B-Cell Lymphoma developing in someone with CLL can be a very devastating disease complication—it requires more aggressive treatments, and actually can have a shortened survival. Sometimes the average survival is a year or even less. So this is a big difference in what the expectations are for someone that had just been living with CLL to have this more aggressive type of cancer.
One of the major challenges is, there’s only a minority of patients that can be cured of this second type of lymphoma with intensive chemotherapy treatment. And the tools we have to result in…and unlike CLL, these aggressive lymphomas need to be cured or people will die of them. The only other results we have to cure them are things like allogeneic stem cell transplant or sometimes CAR T-cell therapy, and sometimes we can’t get enough control over it to get people there, and sometimes the features of it are such that we don’t expect it will respond well to chemotherapies. And people can feel very sick from these.
So Doctor Kater actually presented data with EPKINLY™ (epcoritamab), which is a bispecific antibody. So bispecific antibodies are antibodies that link CLL cells to T cells, which are immune system cells, and then that causes the T cells to attack the CLL. So they are used, and some are approved for aggressive lymphomas—not as Richter’s—and it’s sort of getting the immune system to do the work…like fighting the cancer cells. There are side effects to this, of course. They can make people sick from something called cytokine release because, again, if you think about it, if your T cells are attacking your lymphoma cells, they release the same chemical hormones they release during infections sometimes, so that can make people very ill. But we did see that in people who actually were taking this as a first treatment for these aggressive lymphomas, or Richter’s, we did see that some of them had a benefit of response for multiple months with this. So while it’s not curative, it does mean that people are benefitting, and it would allow them to go on to potentially more effective or curative therapies.
So it was really neat to see that could be achieved without the use of chemotherapy, especially when we have a group of people with Richter’s where we don’t think that their cancer cells will respond well to chemotherapy. So I was very excited to see that update and look forward to seeing what else might be done with bispecific antibodies in Richter’s—and of course with CLL where they’re now being tested.
