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Published byKelley Perry Modified over 9 years ago
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Targeted Therapy in Hematology Dieter Hoelzer – Frankfurt am Main Christoph Zielinski – Vienna, Austria Hans-Joachim Schmoll – Halle, Germany Richard Greil – Salzburg, Austria
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“Magic bullets” in Hematology Rituximab (Mab Thera ) in B-cell NHL Imatinib (Gleevec ) in CML Thalidomide in multiple myeloma Bortezomib (Velcade ) in multiple myeloma
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Rituximab in Non-Hodgkin’s Lymphoma (1) Indications –Follicular lymphoma first line + CT (CVP) –Follicular lymphoma in third line –Diffuse B cell large cell lymphoma in combination with conventional chemotherapy Treatment –375 mg/m², i.v. –weekly as single agent –Three weekly with chemotherapy –Infusion reaction
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Rituximab in Non-Hodgkin’s Lymphoma (2) Questions Other indications for rituximab? Is Id vaccination following chemotherapy superior to passive treatment with anti-CD20 mAb following chemotherapy? Role of radioimmunotherapy for NHL? New antibodies targeting CD20 any better? Other targets in case of resistance against rituximab?
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Imatinib (Gleevec ) in CML (1) Indication Philadelphia chromosome (Ph) positive CML in first line hematologic, cytogenetic and molecular response Treatment –Orally, 400-800 mg/day –GI complaints, muscle cramps, superficial edema, leucopenia, neutropenia
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Imatinib (Gleevec ) in CML (2) Questions Second generation of targeted therapic long-term safety? What to do with AMN107 and BMS-354825 resistant mutants? Combination of drugs any future?
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Thalidomide in Multiple Myeloma (1) Indication Early relapse after 1st and 2nd line therapy or chemotherapy-refractory disease Treatment Orally, 50-400 mg Teratogenic Fatigue – sleepy – constipation, skin rash Polyneuropathy: sometimes irreversible DVT: 1-3%
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Thalidomide in Multiple Myeloma (2) Questions Thalidomide plus dexamethasone standard? Role of lenalidomide (+ dexamethasone)? Long-term outcome?
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Bortezomib (Velcade ) in MM (1) Indication MM patients, who have received at least 2 prior treatment regimens, showing PD Treatment –1.3 mg/m² i.v. push –One cycle: 2 x/week during 2 weeks, then 10 days rest –GI symptomes, tiredness, neuropathy (30%) cytopenia/thrombocytopenia (30%) orthostatic hypotension
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Bortezomib (Velcade ) in MM (2) Questions Can it be used in combination with lenalidomide and lower doses of dexamethasone in order to enhance cytotoxicity end decrease toxicity? Where should bortezomib be positioned?
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