What are the latest developments in blood cancer treatments?

Advance in CAR T therapy eliminates side effects

With new developments in blood cancer treatments, is it changing the future for people with the condition?

Blood cancer is used to describe any cancer that affects the blood, bone marrow or lymphatic system. There are three main blood cancer groups: leukaemia, lymphoma and myeloma.

Leukaemia affects the white blood cells and there are two main types:

• Acute leukaemias

• Chronic leukaemias.

Lymphoma is cancer of the lymphocytes, causing growths to form in the lymph nodes. There are two main types of lymphoma:

• Hodgkin lymphoma

• Non-Hodgkin lymphoma.

Myeloma is cancer of the plasma cells in the bone marrow.

Beyond these three main blood cancers, there are up to 100 different types of blood cancers and other related conditions.

Gemma Peters, Chief Executive of the blood cancer charity Bloodwise, said: “Blood cancers are collectively the third biggest cancer killer in the UK, but we know that awareness of diseases like leukaemia, lymphoma and myeloma and their symptoms is startlingly low.”

Diagnosis

According to the 2017 Cancer Patient Experience Survey published in July 2018,
it is taking longer to diagnose blood cancers than any other types of cancer.

Bloodwise reported that that 35.6% of blood cancer patients who visited their GP with symptoms before diagnosis needed to go three times or more before being referred to hospital.

Speaking at the time, Phil Reynolds, Policy Manager at the charity, said: “We have known for a long time that people with blood cancer can struggle to get a diagnosis and it often takes longer for GPs to refer them to hospital. People with myeloma in particular have to visit their GPs many more times on average before being sent to a specialist.

“This can be explained by a number of factors, including a lack of awareness of blood cancer symptoms and the ease of which many symptoms can be confused with more common conditions.”

Developments in blood cancer treatment

With blood cancer being classed as the third biggest cancer killer, and the fifth most common type of cancer, increasing to the most common cancer amongst children, teenagers and young people in the UK, it’s positive to know that new treatments are being approved.

Blood cancer is commonly treated with chemotherapy, chemo-immunotherapy, radiotherapy, biological therapies, steroids and stem cell transplants.

In May 2018, the National Institute for Health and Care Excellence (NICE) recommended three blood cancer drugs, midostaurin, arsenic trioxide and brentuximab vedotin be made available on the NHS.

Midostaurin, also known as Rydapt, is produced by Novartis. It is a first of its kind drug that targets a protein called tyrosine kinase FLT3, which is often damaged in people with acute myeloid leukaemia. According to NICE, around 160 adults a year in England and Wales, who test positive for the mutated FLT3 gene, will be eligible for this.

Arsenic trioxide or Trisenox is produced by Teva. It is recommended as an option for adults with acute promyelocytic – where the person has fewer healthy blood cells than normal and is given intravenously. NICE estimates that around 140 people a year in England will be eligible for it.

The third drug, brentuximab vedotin, also known as Adcetris, is produced by Seattle Genetics. It was previously only available to people through the Cancer Drugs Fund. NICE says that its approval will mean that around 45 more people a year with a specific type of Hodgkin lymphoma called CD-30 positive will now have an automatic right to the drug.

Meindert Boysen, Director of the NICE Centre for Health Technology Evaluation, said at the time: “For the past 30 years, treatments for leukaemia have changed very little.

“With our positive recommendations for midostaurin and arsenic trioxide we are pleased
to offer patients with leukaemia more treatments than ever before.”

Dr Alasdair Rankin, Director of Research and Patient Experience at Bloodwise, said: “These drugs offer hope to patients with three different types of blood cancer – targeted therapies that for some reduce the chances of relapse and for others offer the chance of a long-term cure or the reduction of severe side-effects connected to traditional treatments.”

Since then, there have been a significant number of announcements about blood cancer treatments.

Blood cancer treatments in the news

NHS England announces ground-breaking new personalised therapy for children with cancer. NHS patients to benefit from Europe’s first full access deal on breakthrough CAR-T therapy. NHS England. September 2018

Janssen announces European Commission approval of Darzalex®θ (daratumumab) as frontline treatment for newly diagnosed patients with multiple myeloma who are transplant ineligible. The Janssen Pharmaceutical Companies of Johnson & Johnson. September 2018

Positive phase III results for Roches Hemlibra for haemophilia A without factor VIII inhibitors published in New England Journal of Medicine. Roche. August 2018

Yescarta receives marketing authorisation for blood cancer. Kite. August 2018

Feedback encouraged to allow use of life extending treatment on NHS for those with blood cancer. CAR-T considered to be an exciting innovation which can cure some patients but very expensive. NICE. August 2018

Novartis receives European Commission approval of its CAR-T cell therapy, Kymriah® (tisagenlecleucel). Novartis. August 2018

NICE change in decision sees BESPONSA®θ (inotuzumab ozogamicin) recommended for relapsed or refractory acute lymphoblastic leukaemia (ALL) patients. Pfizer. August 2018

AbbVie presents data on Venetoclax for the management of blood cancers. AbbVie. June 2018

Personal Story: Andrew Berthoud’s story

Andrew was just three when he was diagnosed with acute lymphoblastic leukaemia in October 2012. His mum, Melody, used daily Facebook posts throughout his treatment to keep his family and friends up to date on how he was doing.

“Andrew was just three and a half when he was diagnosed,” says Melody. “He spent the next three years and four months – almost his whole life again – going through treatment.

“Andrew took his last chemo tablet on 20 February 2016. We filmed this moment that we could only dream of at the start and he spontaneously shouted: ‘I beat you, leukaemia!’ We’re so proud of him.

“Thanks to research, now nine in 10 children survive. But this isn’t enough. One in 10 children won’t survive, and I know that research is the only way to change that. I wanted to share my story so that people know that children and families can survive blood cancer.” 

The chemotherapy caused Andrew severe pain and nausea and Melody remembers that: “I didn’t know that cutting hair short makes it harder to pick out of food when it starts falling out”. The cycles of steroids Andrew needed to take during his treatment also had a big psychological impact on him, with Melody recounting that: “I didn’t know a three-year-old could be depressed”.   

In England in 2016:

12,018 people were diagnosed with non-Hodgkin lymphoma

8208 people were diagnosed with leukaemia

4731 people were diagnosed with myeloma

1717 people were diagnosed with Hodgkin lymphoma

2163 people were diagnosed with myelodysplastic syndromes.

Source: Bloodwise