2020 SOHO Meeting Emphasizes Growing Role of Precision Medicine in Hematologic Malignancies

Despite taking on a new virtual format this year, the Society of Hematologic Oncology (SOHO) hosted their eighth annual meeting on September 9–12, 2020, and nearly doubled attendance compared with years prior. The meeting covered more than a dozen different cancer types through 168 presentations from a multidisciplinary group of internationally recognized experts in hematologic malignancies.¹

“Every year, the SOHO meeting becomes better and better, more diverse, and attracts more visitors internationally, as well as attracts high-quality speakers. SOHO has become a big name among conferences,” Michael Wang, MD, a professor, Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, told Targeted Oncology. “This year, we are in the middle of a pandemic, so we had a virtual meeting, but I think the virtual [meeting] was organized very well.”

Physicians, nurses, and related healthcare specialists attend the SOHO meeting annually to focus on the latest advances in the field and how these approaches can be applied to clinical practice. However, like many other medical conferences this year, the meeting took on its virtual format in response to the coronavirus disease 2019 (COVID-19) pandemic.

“I think virtual conferences are 1 of the best things that have been created [due to] COVID-19. Everything has a bad side and a good side,” Wang said. “The virtual conferences dramatically improved our efficiency and lowered the cost [of attending], attracting more audiences and giving people more freedom. I like the virtual platform of conferences with mixed feelings.”

The virtual format remains new, so many attendees share mixed feelings on this structure, but a benefit of going virtual has been the ability to attend the meeting on one’s own schedule. Content from this year’s meeting, for example, will remain available to attendees until January 2021.

“I miss the old days when I see my colleagues and friends. We sit down together physically, see the presenter in the audience rooms, and I missed that this year,” Wang said. “I always enjoyed standing on the podium to look at the crowd and announce the good results, so I miss that part, but I think the virtual meeting also has beauty [in it] because it’s low cost. We don’t have to travel. We can attend many conferences without booking [flight] tickets and hotel rooms or worrying about coming back and missing days in the clinic.”

SOHO plans to continue utilizing the virtual format of meetings moving forward to help provide more attendees from around the world gain access to the important information and education obtained at the meeting.

“We are making such major progress, particularly in developing therapies that we can expect a major change of how we are going to be managing patients 5 years from now,” Verstovsek told Targeted Oncology. “I invite everybody to join from the community and from a patient's perspective to join and engage together in [terms of] performance in studies to get new drugs approved.”

Precision Medicine Shapes Hematologic Treatment Paradigms

The 2020 SOHO Annual Meeting held true to the theme of “Molecular Classification and Precision Therapy” with emphasis on novel therapeutic approaches in hematologic malignancies. Speakers reviewed important data and education on clinical understandings for a variety of hematologic malignancies, including lymphomas, leukemias, and multiple myeloma, among others, to demonstrate how molecular characterization can be used in practice.²

“This focus on molecular characterization allows us to better define diseases and better subcategorize diseases where they look alike morphologically but behave differently based on their molecular subtypes. This is the future of hematologic malignancies, and I am excited to incorporate this into the theme of the meeting,” Lonial said during his opening remarks at the meeting.

The use of molecular tests in clinical practice continues to become more refined in each disease type, where obtaining this knowledge can help further define disease subtypes in select patients and detect the risk of recurrence. For example, minimal residual disease (MRD) can be detected to potentially determine levels of remission in patients with hematologic malignancies.

Developing better understandings of the disease can help physicians individualize their treatment plans for each patient and utilize precision medicine treatment approaches that target different molecular features. This theme was prevalent across many presentations at this year’s meeting in which treatments include more targeted approaches to treatment of hematologic malignancies. In particular, 1 presentation evaluated the role of BCMA-directed chimeric antigen receptor (CAR) T-cell therapy in multiple myeloma.

During this presentation, speaker Andrezj Jakubowiak, MD, PhD, discussed the latest advances and clinical trials regarding CAR T-cell therapy in patients with multiple myeloma. The majority of data for CAR T cells in this space include BCMA-directed agents, such as LCAR-B38M, which was evaluated in the Legend 2 study. This was the first study to show results of bispecific CAR T cells against 2 epitopes of BCMA.

The study led to an 88% ORR, but patients with BCMA <40% had an ORR of 92% compared with 82% in those who had a BCMA ≥ 40%. This study also evaluated patients who achieved MRD-negativity, whereas the median PFS was 24 months for these patients versus 6 months for those who did not achieve negativity. The 12-month PFS rate was 87% in MRD-negative patients versus 6%.

Several other BCMA-directed CAR T-cell therapies were evaluated during this presentation, which showed positive responses overall, as well as safety. Despite the high rates of response and MRD-negativity, however, the unmet need in this area is that patients are still not being cured, Jakubowiak said. Future studies will help further refine the understanding of why oncologists eventually lose control of the disease with CAR T cells.

Exciting Data from 2020 SOHO Meeting

Presentations at the meeting demonstrated the advancements that have been observed across the hematologic treatment paradigm recently. The treatment landscape continues to shift, providing physicians with more and more therapeutic opportunities for their patients.

“We are making such major progress, particularly in developing therapies that we can expect a major change of how we are going to be managing patients 5 years from now,” Srdan Verstovsek, MD, PhD, medical oncologist, and professor, Department of Leukemia, University of Texas MD Anderson Cancer Center, told Targeted Oncology.

New data from several studies and analyses from other clinical trials were presented at this year’s meeting that demonstrate further improvements in the field. In particular, these included advances in multiple myeloma, acute lymphoblastic leukemia (ALL), and classic Hodgkin lymphoma (cHL), among others.

Modified Pediatric Regimen Improves Outcomes in Young Adult Patients With Acute Lymphoblastic Leukemia​

Findings from a retrospective analysis demonstrated that the use of a modified pediatric regimen to treat adolescents and young adults with ALL led to superior outcomes compared with historical conventional adult regimen data. Saleem Eldadah, MD, shared these data during the meeting, in which he stated, “Using this pediatric ALL protocol in adult patients is feasible, but more work is needed to further improve outcomes and decrease toxicities.

The modified regimen consisted of induction followed by 8 weeks of augmented consolidation. Investigators found that the pediatric-inspired regimen induced a complete response (CR) rate of 94.7%. After a median follow-up of 4.9 years, the 5-year overall survival (OS) was 80%, and the 5-year event-free survival was 65%.

These findings suggest that adolescents and young adults, much like pediatric patients, should also receive different treatment than adult counterparts. This finding is an important observation as the outcomes in this patient population tend to be poor, especially when compared with the survival that has been observed in younger children with ALL.

HIV-Positivity in Classic Hodgkin Lymphoma Shows Comparable Outcomes to Patients Without HIV​

Clinical outcomes appeared similar between patients with cHL and human immunodeficiency virus (HIV) and those without HIV in terms of OS in an observational study, but relapse-free survival (RFS) was statistically shorter in patients with HIV. For this study, outcomes were assessed for patients who received a chemotherapy regimen of doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine along with continued combined antiretroviral therapy, in the frontline setting.

The median OS had not yet been reached in all patients on the study, but patients without HIV appeared to have a longer OS, according to a Cox regression model. The CR rate was 66.1% in the non-HIV population compared with 61.1% in the HIV group, while the median RFS was 51 months versus 24 months, respectively.

During his presentation of these data, Juan José del Moral Díez, MD, said that although the RFS favored patients without HIV, the OS was similar in both cohorts of patients, so it is possible that rescue therapy may be effective in such relapsed patients.

Ixazomib Combination Shows 13+ Month PFS in Multiple Myeloma​

The phase 3 TOURMALINE-MM2 study demonstrated an increase of 13.5 months in the median progression-free survival (PFS) with ixazomib (Ninlaro) in combination with lenalidomide and dexamethasone as treatment of patients with newly diagnosed multiple myeloma who are ineligible for transplant. Although the study did not meet its primary end point of PFS, nor did it meet the threshold for statistical significance, the study still demonstrated the efficacy of the combination compared with lenalidomide, dexamethasone, and placebo.

The median PFS was 35.3 months with ixazomib versus 21.8 months with placebo in the overall population. For patients with high-risk cytogenetics, the median PFS was 23.8 months with ixazomib versus 18.0 months with placebo, demonstrating that these findings are also important for high-risk patients. The lead study author, Thierry Facon, MD, noted that these data should inform future research and further progress for the treatment landscape of myeloma.

<< Check out more from the 2020 SOHO Annual Meeting, including exclusive interviews with select speakers​

_References

_{1. Lonial S. Closing Remarks. Presented at: 2020 Society of Hematologic Oncology Virtual Annual Meeting; September 9-12; Virtual.}

_{2. Lonial S. Opening Remarks. Presented at: 2020 Society of Hematologic Oncology Virtual Annual Meeting; September 9-12; Virtual.}