Dr. Usmani Discusses Immunotherapy in Hematologic Malignancies

Saad Z. Usmani, MD, Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Carolinas HealthCare System, discusses immunotherapy in hematologic malignancies.

Efficacy targeting the PD-1/PD-L1 pathway was first observed with nivolumab (Opdivo) in Hodgkin lymphoma, says Usmani. The original clinical observations were published in the New England Journal of Medicine in 2015. Since then, several clinical trials have explored PD-1/PD-L1 inhibitors in the frontline setting, as well as in the post-transplantation setting. Usmani says that good activity has been observed.

In multiple myeloma, the only clinical data that is available is with pembrolizumab (Keytruda) in combination with lenalidomide (Revlimid) and dexamethasone, as well as in combination with pomalidomide (Pomalyst) and dexamethasone. In 2017, the FDA put a hold on the phase III clinical trials of these combinations, and subsequently, checkpoint inhibition was deemed unsafe when paired with immunomodulatory drugs. However, newer clinical trials of checkpoint inhibitors in myeloma are showing promise when combined with other drug classes.

Immunotherapy is moving forward in myeloma, Usmani says. In addition to the work with PD-1/PD-L1 inhibitors, trials with CTLA-4 inhibitors are being developed.