Dr Danish on Post-CAR T-Cell Bridging Radiation Therapy Eligibility in High-Risk NHL

Adnan F. Danish, MD, chief, Division of Radiation Oncology, St. Joseph’s Health; radiation oncologist, John Theurer Cancer Center, Hackensack University Medical Center, discusses findings from a study evaluating the prevalence of patients with high-risk non-Hodgkin lymphoma (NHL) who were eligible for bridging radiation therapy prior to receiving CAR T-cell therapy, as well as the outcomes of these patients following CAR T-cell therapy.

This single-center, retrospective study included 81 patients with relapsed/refractory NHL who received CAR T-cell therapy between the years of 2018 and 2022. The CAR T-cell products that patients received included axicabtagene ciloleucel (Yescarta; 62%), lisocabtagene maraleucel (Breyanzi; 16%), tisagenlecleucel (Kymriah; 15%), and brexucabtagene autoleucel (Tecartus; 7%).

Patients were deemed eligible for bridging radiation therapy if they had less than 5 malignant lesions according to pre-apheresis radiological study results. Patients were classified as having high-risk disease if they had bulky disease of at least 10 cm, at least 1 extranodal site, lactate dehydrogenase levels above normal, or at least 1 lesion with an SUVmax of at least 10. Investigators found that 40 patients (49%) included in this study would have been eligible for bridging radiation therapy. Among these patients, 29 had disease with high-risk features, including 4 with bulky disease, 6 with 1 or more lesions with an SUVmax of at least 10, and 2 with at least 1 extranodal site. Of the 40 eligible patients, 9 received bridging radiation therapy, 2 of whom had high-risk disease.

Among patients with a high risk of disease relapse after CAR T-cell therapy, 44% experienced either a partial response, stable disease, or progressive disease at 3 months post–CAR T-cell therapy. Moreover, 1 patient with transformed diffuse large B-cell lymphoma (DLBCL) had persistent disease in the nasopharynx following 3 cycles of R-CHOP (rituximab [Rituxan], cyclophosphamide, doxorubicin, vincristine, and prednisone) and R-HyperCVAD (rituximab, cyclophosphamide, vincristine, doxorubicin, methotrexate, cytarabine, and dexamethasone). This patient received radiation therapy as a bridge to CAR T-cell therapy, which led to a continued complete response (CR) at 23 months of follow-up. Another notable patient with non–double-hit, germinal center B–like DLBCL achieved a CR with 6 cycles of R-CHOP, and experienced disease relapse less than 1 year later. This patient then received bridging radiation therapy, and experienced disease relapse 6 months after CAR T-cell therapy.

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Adnan F. Danish, MD, discusses findings from a study evaluating the prevalence of patients with high-risk non-Hodgkin lymphoma who were eligible for bridging radiation therapy prior to receiving CAR T-cell therapy, as well as the outcomes of these patients following CAR T-cell therapy.

Adnan F. Danish, MD, radiation oncologist, John Theurer Cancer Center, Hackensack University Medical Center, chief, Division of Radiation Oncology, St. Joseph’s Health, discusses the potential for SCINTIX radiation technology to open new treatmentopportunities for patients with cancer, including those with lung and bone cancers, whose disease has metastasized to more than 5 sites.

In February of 2023, the FDA granted clearance to SCINTIX biology-guided radiotherapy

 for use in patients with primary or metastatic lung and bone tumors, supplementary to the prior clearance of SCINTIX for intensity-modulated radiation therapy, stereotactic body radiation therapy, and stereotactic radiosurgery in all solid tumors.

Previously reported data indicated that patients who present with up to stage IV cancer with disease involving multiple sites who receive ablative therapy along with standard-of-care (SOC) systemic therapy seem to have a better chance of survival than those who do not receive this combination approach, Danish begins. However, this benefit has not been translated to patients who have disease involving more than 5 sites, he says. This is because the technology has not been capable of handling those disease presentations, he explains.

To combat this unmet need, with the use of SCINTIX radiation technology, using PET to guide the radiation, oncologists should be able to treat more patients than before, Danish expands. Therefore, investigators now wish to show a benefit with ablative therapy plus systemic therapy in patients with polymetastatic disease.

Investigators continue to look at ways of combining radiation therapy with other targeted therapies, such as immunotherapies, therapies that are targeted towards specific receptors, or even SOC chemotherapy, Danish continues. Moreover, investigators hope to use ablative therapy to treat patients with stage IV disease and determine the effect of this therapy on their disease outcomes, he says. Although data support this approach, research efforts are constrained by the limits of current technology, Danish concludes.

Adnan F. Danish, MD, discusses the potential for SCINTIX radiation technology to open new treatment opportunities for patients with cancer, including those with lung and bone cancers, whose disease has metastasized to more than 5 sites.


Dr Danish on the Potential for Treatment with SCINTIX Radiation Technology in Lung and Bone Cancers

Adnan F. Danish, MD, radiation oncologist, John Theurer Cancer Center, Hackensack University Medical Center, chief, the Division of Radiation Oncology, St. Joseph’s Health, discusses the methodologies behind the use of SCINTIX radiation technology in metastatic bone and lung tumors, detailing how this technology differs from computed tomography (CT) or magnetic resonance imaging (MRI) scans prior to treatment.

the FDA granted clearance to SCINTIX biology-guided radiotherapy in February of 2023

 for patients with primary or metastatic lung and bone tumors. This clearance is supplemental to the already-cleared use of SCINTIX for intensity-modulated radiation therapy, stereotactic body radiation therapy, and stereotactic radiosurgery in all solid tumors.

With SCINTIX, clinicians can use the same radiotracer that has been used to diagnose patients’ cancer in multiple locations to then guide radiation therapy, Danish begins. This functional imaging data from the PET scans will direct personalized radiotherapy that differs from CT scans and MRIs, he says. CT scans and MRIs provide clinicians with a snapshot of where the tumor is located and what it looks like in that moment in time. This information, in conjunction with historic information about tumor motion, has been used to best understand how to deliver radiation to patients, he explains.

However, with this SCINTIX technology, as the radiotracer is taken up by the cancer, it will deliver information in real time to guide the radiation, Danish emphasizes. Therefore, SCINTIX is using functional data in comparison with just anatomic data for the treatment of patients with radiotherapy, Danish says.

This approach takes treatment to the next level, as it is more personalized for patients, Danish continues. Clinicians are moving toward the personalized treatment of cancer, as not all patients’ cancers move the same as each other or look the same as each other, he says. Clinicians will continue to take advantage of this technology to treat each patient individually, which will help to offer more precise and better care for patients, Danish concludes.

Adnan F. Danish, MD, discusses the methodologies behind the use of SCINTIX radiation technology in metastatic bone and lung tumors, detailing how this technology differs from computed tomography or magnetic resonance imaging scans prior to treatment.

Dr Danish on the Potential Use of SCINTIX Radiation Technology in Bone and Lung Tumors

Adnan F. Danish, MD, radiation oncologist at John Theurer Cancer Center, Hackensack University Medical Center, chief, the Division of Radiation Oncology, St. Joseph’s Health, discusses the use of SCINTIX radiation technology in metastatic bone and lung tumors.

the FDA granted clearance to SCINTIX biology-guided radiotherapy

for the treatment of patients with primary or metastatic lung and bone tumors. The technology is also cleared for intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and stereotactic radiosurgery for all solid tumors.

SCINTIX represents a new way of treating patients, Danish begins. IMRT has had a defined role in the oncology treatment space, and SBRT has allowed patients to receive higher doses of radiation in a single session, he explains. SCINTIX represents an addition to these treatment modalities that allows for the use of the biology of a patient’s tumor to help guide treatment, Danish says. 

Just as PET imaging has changed the way patients are diagnosed and treated, this technology combines imaging with treatment to improve the delivery of standard-of-care IMRT and SBRT, he continues.

For tumors of the lung and bone that are active on a PET scan, it will now be possible to better deliver local treatment for those lesions, Danish continues. Additionally, it is now possible to combine multiple modalities in 1 setting to treat more than 1 tumor, which was not previously possible, he says. Clinicians can now use the tumor’s activity to focus the radiation, thus allowing for more accurate delivery of radiation, Danish concludes.

Adnan F. Danish, MD, discusses the use of SCINTIX radiation technology in metastatic bone and lung tumors.


Dr Danish on the Use of SCINTIX Radiation Technology in Metastatic Bone and Lung Tumors

Adnan F. Danish, MD, radiation oncologist at John Theurer Cancer Center, Hackensack University Medical Center, chief, the Division of Radiation Oncology, St. Joseph’s Health, discusses unmet needs in the treatment of patients with lung and bone cancers, and how 

unmet needs within this patient population are being addressed with the utilization of SCINTIX radiation technology

In February 2023, the FDA granted clearance to SCINTIX biology-guided radiotherapy for the treatment of patients with primary or metastatic lung and bone tumors. SCINTIX is also cleared for the use of intensity-modulated radiation therapy, stereotactic body radiation therapy, and stereotactic radiosurgery for all solid tumors.

Although tumors of the lung and bone account for approximately about 70% of annual cancer deaths from solid tumors, many of these patients do not receive radiation therapy due to logistical and technical challenges that arise when attempting to treat multiple tumor locations in a single treatment session, Danish says. With traditional radiotherapy, the need to localize a tumor and treat it requires a separate session for each radiation treatment, Danish adds.

SCINTIX radiation technology could address these challenges by allowing for the delivery of precise, multimodal therapy to multiple metastatic disease sites in a single session, Danish continues. Previously, the presentation of metastatic disease with lung and bone involvement would have precluded patients from receiving radiation; however, when these sites are simultaneously involved, these patients could potentially be candidates for SCINTIX radiation technology, he adds. Ultimately, this could allow for more patients to gain access to a treatment modality that would have previously been unfeasable, Danish concludes.

Adnan F. Danish, MD, discusses unmet needs in the treatment of patients with lung and bone cancers, and how unmet needs within this patient population are being addressed with the utilization of SCINTIX radiation technology.


Dr Danish on the Challenges of Radiation Treatment in Lung and Bone Cancers

Adnan F. Danish, MD, radiation oncologist at John Theurer Cancer Center, Hackensack University Medical Center, chief, the Division of Radiation Oncology, St Joseph’s Health, discusses 

the use of novel radiotherapy approaches in cancer care

Despite the benefits to treatment seen with radiotherapy, challenges still remain within this treatment modality, Danish begins. For example, imaging can detail the exact location of a tumor at a specific point in time; however, tumors can shift due to movement and changes in anatomy, Danish says. Therefore, margins of error are added to radiotherapy to accommodate for any shifts in the tumor. Over time, changes have been made to better address this issue, and pinpointing real-time locations of tumors is now easier, Danish explains. In turn, this has led to a decrease in margin of treatment, reducing adverse effects that may occur as a result of stray radiation, Danish adds. Up until this point in time, beacons or fiducials implanted in tumors have helped provide real-time location for tumors and confirm the deliver of radiation therapy, Danish expands.

However, there is now the ability to use the tumor itself as a beacon to guide radiation therapy, Danish notes. SCINTIX radiation technology is designed to deliver precise, multimodal therapy to metastatic disease sites in patients with advanced lung and bone cancers, Danish explains. Rather than assuming that the tumor is stationary and adding a margin to accommodate for changes in anatomy motion, this technology detects motion and changes in anatomy to guide radiation treatment, Danish continues. Therefore, patients can be treated with a much smaller margin with an increased therapeutic ratio of treatment, Danish concludes.

Adnan F. Danish, MD, discusses the use of novel radiotherapy approaches in cancer care.


Adnan F. Danish, MD

Articles

Dr Danish on Post-CAR T-Cell Bridging Radiation Therapy Eligibility in High-Risk NHL

Dr Danish on the Potential for Treatment with SCINTIX Radiation Technology in Lung and Bone Cancers

Dr Danish on the Potential Use of SCINTIX Radiation Technology in Bone and Lung Tumors

Dr Danish on the Use of SCINTIX Radiation Technology in Metastatic Bone and Lung Tumors

Dr Danish on the Challenges of Radiation Treatment in Lung and Bone Cancers

Dr Danish on the Use of Novel Radiotherapy Approaches in Cancer Care