Second Line Therapy: The Past, Present, And Future Of Treating Hematological Cancers

By Robert S. Negrin, MD, Professor of Medicine and former Chief of the Division of Blood and Marrow Transplantation at Stanford University, Biorasi Scientific Advisory Board member

Hematological cancers make up nearly 10 percent of new cancer cases in the United States, encompassing lymphoma, leukemia, and myeloma, with 13 subtypes. Each year, over 600,000 deaths are attributed to blood cancer. The primary treatment for the most common lymphoma type, diffuse large B cell lymphoma, is the CHOP chemotherapy and antibody regimen, comprising cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (oncovin), and prednisone. However, advancements in cell therapy offer alternative options for patients if the initial treatment proves ineffective.

“Unfortunately, about 40 percent of patients relapse after frontline treatment, and the cancer returns,” noted Dr. Robert Negrin. “The standard response in this situation had been to recommend a bone marrow transplant. Today, when compared to transplant options, for some patients, CAR T-cell therapy has been shown to be a superior treatment and it has been moved up to the second line of treatment after chemotherapy and CHOP for those patients who relapse within 12 months of initial therapy.”

What was once science fiction has moved up to second line therapy, which gives greater access to patients and allows for a greater impact. In this article, Dr. Negrin navigates the trajectory of CAR T-Cell Therapy from early HIV therapy to second line treatment for diffuse large B cell lymphoma.