Dr. Sauter on Questions Surrounding Novel Therapies in Hematologic Malignancies

Craig Sauter, MD, director, Blood and Marrow Transplant Program, Hematology and Medical Oncology, the Cleveland Clinic, discusses prominent questions surrounding new and emerging therapies in the treatment of patients with hematologic malignancies.

A key point of contention in the hematologic oncology space currently centers around treatment decisions for patients following platinum-containing salvage therapy in the second-line setting. If a patient in the community setting clears a PET scan or has complete metabolic response to salvage chemotherapy, should treatment consolidation consist of a traditional autologous stem cell transplant (ASCT) or CAR T-cell therapy, Sauter says. This topic was debated at 2023 Transplantation and Cellular Therapy Meetings, and it is a practical point of discussion in real-world practice, Sauter continues.

Although physicians also likely have questions about new and emerging agents in the pipeline for treating hematologic malignancies following second-line salvage chemotherapy, it remains difficult to give clear expectations for these agents because many are still in early phase testing, Sauter notes, adding that clinicians and researchers must first conduct studies of these agents on a larger scale.

As treatment options currently stand, if a patient achieves a complete metabolic response to second-line platinum-containing salvage chemotherapy, Sauter would favor an ASCT because established data have shown that approximately 60% to 70% of patients will be cured, Sauter continues. However, this data is not yet available with CAR T-cell therapy. That said, there is a pharmacoeconomic consideration for patients that have undergone apheresis and generation of their CAR T-cell product, adding to the debate between ASCT and CAR T-cell therapy in this setting, Sauter explains.

As more therapies emerge, such as bispecific antibodies, continue to emerge, sequencing choices will be a key issue to address, Sauter continues. Although these different agents may demonstrate efficacy, it is unknown what the optimal sequencing strategy will be from a biological standpoint, Sauter concludes.