Take-Home Messages From the NCCN Hematologic Malignancies Conference 

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As the National Comprehensive Cancer Network (NCCN) 8th Annual Congress: Hematologic Malignancies was drawing to a close, The ASCO Post spoke with Andrew D. Zelenetz, MD, PhD, about the themes of the meeting and the take-home messages for attendees and for our readers. Dr. Zelenetz is Vice Chair for Informatics in the Department of Medicine at Memorial Sloan-Kettering Cancer Center, New York, and Chair of the NCCN Congress on Hematologic Malignancies.

Explosion in Genomics

The main theme of the meeting, as at many medical meetings these days, was the wealth of knowledge now at our fingertips, given the ability to sequence the whole genome and the subsequent explosion in genomics.

Sticking with that theme, three presentations focused on genomics in hematologic malignancies: Ross L. Levine, MD, on “Genomics and the Era of Personalized Medicine,” Richard M. Stone, MD, on “Clinical Genomics in Myeloid Malignancies,” and Jeffrey Jones, MD, MPH, on “Targeting Novel Signaling Pathways in B-Cell Malignancies.”

“By itself, Dr. Levine’s talk was indicative of where the field is moving, which is trying to understand the molecular pathways involved in a range of hematologic malignancies as well as solid tumors. Dr. Stone’s talk tempered our current enthusiasm, since our ability to act on specific mutations that can be identified is limited at present. The reality is first we need to identify the mutations, then identify the target, and then develop drugs or use available drugs to target the targets,” Dr. Zelenetz explained.

“Dr. Jones’ talk opened the door to the future. Drugs targeting novel signaling pathways will revolutionize our treatment of chronic lymphocytic leukemia and will have an important impact on other B-cell malignancies. The recognition that signaling via the B-cell pathway was an important target gave us tremendous insight. We have multiple tools to inhibit that signaling,” Dr. Zelenetz continued.

Novel Agents, Molecular Modeling Updates

“At Memorial Sloan-Kettering Cancer Center, we are starting to see the fruits of our research in relapsed/refractory acute myeloid leukemia (AML). As a consequence of identifying the isocitrate dehydrogenase (IDH) mutations, we are targeting a new pathway with an IDH inhibitor in a very early study. Before this, we had no idea of what the targets might be in AML,” he explained.

Other presentations at the NCCN Congress included updates on molecular modeling for the use of tyrosine kinase inhibitors in chronic myeloid leukemia and monitoring responses, management of Philadelphia chromosome–positive acute lymphocytic leukemia and use of tyrosine kinase inhibitors in that malignancy, interim PET scanning in Hodgkin lymphoma, a discussion on how to integrate new agents in relapsed/refractory multiple myeloma, and a talk on management of bone health in multiple myeloma.

Rare Diseases

Two speakers focused on rare lymphoid malignancies. Ranjana H. Advani, MD, discussed lymphocyte predominant Hodgkin lymphoma, another B-cell lymphoma that behaves like an indolent lymphoma. About half the audience was not able to identify this disease as a B-cell lymphoma before Dr. Advani’s talk, Dr. Zelenetz noted.

Leo Gordon, MD, discussed rare lymphomas. “He told listeners that the marked sensitivity of patients with Waldenstrom macroglobulinema to ibrutinib who have the MYD88 (L265P) mutation might herald a treatment breakthrough,” he commented.

“Overall, we are seeing the increasing impact of understanding specific pathways of mutation. This is beginning to shape not only our biological appreciation of these illnesses, but also our treatment options,” Dr. ­Zelenetz concluded. ■

Disclosure: Dr. Zelenetz reported no potential conflicts of interest.

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