ASH Clinical News Focus on Rare Diseases | Page 26
MEETING COVERAGE
Examining Mogamulizumab for T-Cell Leukemia and
Lymphoma
Patients with adult T-cell leukemia and lymphoma (ATLL), a rare
T-cell malignancy caused by the human T lymphotropic virus type
1 (HTLV-1), have limited therapeutic options. With no established
standards of care, most patients are treated with the same cytotoxic therapies used in other T-cell malignancies. Results from a
randomized phase II trial presented at the 2016 American Society
of Clinical Oncology (ASCO) Annual Meeting suggests that the novel
anti-CCR4 antibody mogamulizumab induces better response rates
than currently available therapies. ASH Clinical News spoke with
Adrienne A. Phillips, MD, MPH, who presented the results, about
mogamulizumab and the future of immune-based therapies for
ATLL.
What is ATLL, and why are you studying mogamulizumab?
ATLL is a T-cell neoplasm that we don’t see commonly in the
United States; it’s more common in Japan, Latin America, and the
Caribbean. We know that ATLL is caused by the HTLV-1 virus,
but we only see a few cases. The Surveillance, Epidemiology, and
End Results database estimates that there are about 120 cases
per year in the United States – primarily in centers that treat
immigrants who come from regions where ATLL is endemic.
In Japan, mogamulizumab has been approved for the
treatment of ATLL; outside of Japan, ATLL patients have limited
treatment options. With the current trial, which is the largest
study in relapsed/refractory ATLL, we enrolled 71 patients from
sites in the United Kingdom, France, Brazil, Peru, and Martinique.
We had to open the trial at 22 sites around the world because the
disease is just that uncommon.
It was a herculean effort, but we did it. Personally, this trial
taught me the importance of working together with multiple
centers. I tried to open a single-center study to treat patients
with ATLL when I was just out of fellowship, but I had to close
it because I couldn’t accrue enough patients. So, this was a great
accomplishment for ATLL patients.
Because ATLL is so rare, there aren’t any real guidelines
mandating treatment – is the treatment choice up to the
physician in most situations?
It is. In this trial, patients were randomized to receive
mogamulizumab or an investigators’ choice. We polled the lead
investigators to assess what their choices might be, because we
don’t have a standard therapy for this disease. Since there isn’t
a standard therapy for ATLL, they have been using drugs that
are active in other T-cell malignancies, such as methotrexate,
dihydroxyacetone phosphate, and gemcitabine plus oxaliplatin.
What did you find in this study?
There were two interesting observations. First, mogamulizumab
was effective for patients with ATLL, producing an overall
response rate of about 34 percent, as assessed by the investigator.
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Focus on Rare Diseases
Adrienne A. Phillips, MD, MPH
Second, when we looked at the response rate to investigators’
chosen therapies, the response rate was zero; there was little
therapeutic benefit with these cytotoxic regimens. This showed
that our currently available options are really ineffective. We
need to continue to investigate novel agents for patients with this
disease.
What are the next steps for mogamulizumab?
The sponsoring pharmaceutical company is in talks with the U.S.
FDA to safely advance this drug forward and make it available for
ATLL patients outside of Japan. Although the 34 percent response
rate is encouraging, it’s not a “home run,” so we’re still looking for
other therapies and combinations that will be even more effective
for ATLL patients.
We studied mogamulizumab as a single agent; perhaps in
future trials, we will look at combining it with other agents. The
study results also confirmed that immunotherapy is a promising
area of research for ATLL patients. It might be the future of this
disease. ●
Adrienne A. Phillips, MD, MPH, is assistant professor of medicine
at Weill Cornell Medical College and assistant attending physician
at the New York-Presbyterian Hospital in New York.
Reference
Phillips AA, Fields P, Hermine O, et al. A prospective, multicenter, randomized
study of anti-CCR4 monoclonal antibody mogamulizumab (moga) vs
investigator's choice (IC) in the treatment of patients (pts) with relapsed/
refractory (R/R) adult T-cell leukemia-lymphoma (ATL). Abstract #7501.
Presented at the 2016 American Society of Clinical Oncology Annual Meeting, June 6,
2016; Chicago, IL.