ASCO 2010: What’s Next for CML Patients?

Dr. Sonali Smith discusses treatment innovations for CML.

Selma R. Schimmel, Founder & CEO, Vital Options International: What happens now in the research? What is the next phase?

Sonali Smith, MD, Assoc. Professor of Med., University of Chicago Med. Center: That’s an excellent question. And the challenge here is that dasatinib is – this is a very promising study – but the challenge is that dasatinib is not the only tyrosine kinase inhibitor being developed for this reason, in other words, for patients who have chronic myelogenous leukemia. The other compounds are also more potent than imatinib, but they’ve never been compared to each other. So in terms of what happens next, I think, for me as a physician what I would tell my patients is that there are options that are going to be out there, that these options may be better, but we really do need to wait for a little bit more time to go by before we know if any of these agents help people live longer or live better. All we know is that right now patients respond.

Selma R. Schimmel: And what role will transplant still play for these patients?

Sonali Smith: So transplant, it’s very, it’s incredible actually because within the span of ten years it went from being the classic disease that went through an allo-transplant to now it is such a rarity to have a patient…

Selma R. Schimmel: It is incredible, isn’t it?

Sonali Smith: Unbelievable… to have a patient with CML who needs an allogeneic transplant is so uncommon, you know. We’re a medium-sized institution and I mean I think there have been maybe two patients in the last three years that have gone through an allogeneic transplant for CML.

Selma R. Schimmel: The age range for the trial, what was it?

Sonali Smith: Yes, the average age on the study was somewhere in the 50s and the average age for CML is actually just a touch older, it’s probably in their, in the sixth decade. But it was still a very, you know, applicable group of patients.

Selma R. Schimmel: I just can’t help thinking about the history of leukemia and in this case, CML and how far we’ve come from the manner in which we used to tried to manage this disease. And I think that’s the theme of this whole meeting is that we have gone from that age of aggressive, whether it’s transplant or you know, cytotoxic agents to understanding as we look at the biology of disease and the world of molecular and targeted therapies.

Sonali Smith: I could not agree more. I mean, the investment in cancer research is paying off.

Selma R. Schimmel: And you represent, I hope you’re happy to hear me say, the younger generation of doctors, that you’re at the cusp of this paradigm shift and so you are going to get to live through in medicine, really, this most dramatic time. You know, a decade from now we probably won’t recognize the way we used to treat our cancers.

Sonali Smith: I do feel very privileged to be caring for patients in this time period and to be able to give them these types of options that are based on a rational understanding of what a cancer cell happens. We still have a lot of work to do, of course, and not every cancer is as well understood as something like CML, but there is a very huge shift towards personalized medicine, towards innovative approaches as opposed to chemotherapy and I think there is quite a lot of hope.

Selma R. Schimmel: So as you leave this meeting, is there in addition to the study we’ve just talked about, is there something that has really impressed you that has been the most compelling component of this particular ASCO meeting?

Sonali Smith: Yes, it’s interesting- I focus on blood cancers and so that’s really where I’ve been, you know, attending and learning. But that being said, the two things that strike me the most in this meeting is a melanoma abstract that was presented and now published in the New England Journal of Medicine, apparently as of today, I’ll tell you about that in a second, and also a lung cancer paper.

And both of these studies, the melanoma one uses a monoclonal antibody against a target that is not on the cancer cell but on the immune system cells that have somehow tolerated the melanoma. And by getting rid of that immune cell, the melanoma cells die. And for me to see that kind of advance in a disease that has been very difficult is incredible.

And then with the lung cancer, I almost feel like lung cancer is turning into a blood cancer in a sense that you know, lung cancer for a long time I think, was thought of as one disease and it’s very clear, lung cancer is complex. There are subgroups of patients and if you can find the right drug for the right subgroup they do better. And that’s where this ALK-inhibitor really comes into play, and you know, it’s just incredible to see that type of innovation.

Selma R. Schimmel: Thank you Dr. Smith.

Sonali Smith: Oh, my pleasure. Thank you very much. It’s so nice to see you again.

Selma R. Schimmel: It’s good to see you too.

[End of video]