Targeted drugs and immunotherapies may lower risk of hematologic cancers

Trend of reduced therapy-related hematologic cancers among patients with three cancer types likely driven by immune modulation, Roswell Park team proposes

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BUFFALO, N.Y.—While breakthrough treatments have emerged for several cancers over the last two decades, driving striking improvements in survival and other clinical outcomes, too little is known about the risk of therapy-related hematologic cancers following targeted and immunotherapeutic approaches. In a study to be presented at the American Society of Clinical Oncology (ASCO) 2020 virtual meeting, a Roswell Park Comprehensive Cancer Center team reports that in many cases, these newer treatment approaches may reduce the risk of therapy-related myelodysplastic syndrome or acute myeloid leukemia (tMDS/AML) compared to chemotherapy-based treatment strategies.
Using 17 population-based Surveillance, Epidemiology and End Results (SEER) cancer registries, a team led by Dr. Swapna Thota and Abhay Singh evaluated the cases of 565,149 patients diagnosed between 2000 and 2015 with melanoma, non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC) or multiple myeloma. Current standard treatment for all of these cancer types relies on drugs that stimulate the immune system—tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) in the case of NSCLC, RCC and melanoma and immunomodulatory imide drugs (IMiDs), in the case of multiple myeloma.
“We hypothesized that increased immune surveillance after treatment with these drugs could halt clonal evolution and reduce risk of therapy-related hematologic cancers—specifically, myelodysplastic syndrome or acute myeloid leukemia,” said Thota, an assistant professor of Oncology in the Department of Medicine.
“Our data suggest that tMDS/AML risk is indeed declining in specific cancer cohorts for three of the cancer types we studied—NSCLC, RCC and melanoma—but not in myeloma,” said Singh, a hematology-oncology fellow in the Department of Medicine. “We believe that a protective effect of immune checkpoint inhibitors and immunomodulatory agents, in addition to the relatively low leukemogenic effects of these therapies, likely contributed to this trend.”
Co-authors on this work include Dr. Megan Herr, an assistant professor of oncology in the Department of Medicine.
In recognition of his contributions to this important research, Singh was awarded the Conquer Cancer–Syndax Pharmaceuticals Inc. Endowed Merit Award, which recognizes a fellow who submitted a high-scoring abstract focused on acute leukemias.

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