ASH 2023 | The management of Richter’s transformation: current approaches and future outlooks
In this video, Danielle Brander, MD, Duke University School of Medicine, Durham, NC, discusses her hopes to move away from the standard of care (SoC) treatment for patients with Richter’s transformation (RT), which remains a challenge in the field of chronic lymphocytic leukemia (CLL). Dr Brander emphasizes that the approach to patients with RT has evolved, with novel agents including CAR-T cells and bispecific antibodies being explored. Understanding the diversity of patients with Richter’s is important and approaching these patients using targeted or cellular therapy rather than standard chemoimmunotherapy (CIT) may be of benefit. This interview took place at the 65th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (edited for clarity)
For as much as novel therapeutics have improved responses and survival for patients with CLL or previously treated CLL, unfortunately I feel like the bar or the needle hasn’t moved very much for patients with Richter’s, whose survival is markedly short compared to CLL, often less than a year. So where I hope research moves things is that we can get away from what really has been the standard for Richter’s, which is chemoimmunotherapy because so many patients either don’t respond or they have brief responses and then progression...
For as much as novel therapeutics have improved responses and survival for patients with CLL or previously treated CLL, unfortunately I feel like the bar or the needle hasn’t moved very much for patients with Richter’s, whose survival is markedly short compared to CLL, often less than a year. So where I hope research moves things is that we can get away from what really has been the standard for Richter’s, which is chemoimmunotherapy because so many patients either don’t respond or they have brief responses and then progression.
And so trials, importantly, or just the way we approach patients from the start, I think has evolved. Of course, many of us too won’t just take a chemoimmunotherapy approach when patients have been exposed to novel agents, such as BTK inhibitors, we’ll at least keep that going or switch inhibitors and combine it with chemotherapy. But ultimately to maintain the response, since we know that patients with Richter’s that’s related to their CLL will, even if in a good response, be likely to relapse, we’re starting to see, for example, reports of using CAR-T or cellular therapy for those patients or bispecific antibodies.
So I really think as we understand that diversity for patients, most of them having high-risk mutations that aren’t going to respond to chemotherapy or have been exposed to novel drugs, that we’ll start from the start approaching patients with a new diagnosis of Richter’s differently and getting them to an agent or cellular therapy to try to maintain that response.
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Disclosures
Juno/Celgene/BMS: Other: Site PI clinical trial (grant paid to institution, Research Funding; Beigene: Other: Site PI clinical trial (grant paid to institution), Research Funding; MEI Pharma: Other: Site PI clinical trial (grant paid to institution), Research Funding; Ascentage: Other: Site PI clinical trial (grant paid to institution), Research Funding; Novartis: Other: Site PI clinical trial (grant paid to institution), Research Funding; Catapult: Other: Site PI clinical trial (grant paid to institution), Research Funding; DTRM: Other: Site PI clinical trial (grant paid to institution), Research Funding; Pharmacyclics: Consultancy, Other: Site PI clinical trial (grant paid to institution), Research Funding; ArQule/Merck: Other: Site PI clinical trial (grant paid to institution), Research Funding; AstraZeneca/Acerta: Other: Site PI clinical trial (grant paid to institution), Research Funding; NeWave: Other: Site PI clinical trial (grant paid to institution), Research Funding; AbbVie: Consultancy, Other: Site PI clinical trial (grant paid to institution), Research Funding; Genentech: Consultancy, Other: Site PI clinical trial (grant paid to institution), Research Funding; TG Therapeutics: Other: Site PI clinical trial (grant paid to institution), Research Funding; Pharmacyclics: Other: Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid for NCCN panel member CLL/SLL and HCL, informCLL registry steering committee; AbbVie: Other: Core registry steering committee ; CLL Society: Other: Alliance in Clinical Trials: Leukemia committee member & Trial Champion of S1925 .
