ESMO 2024 highlights

The European Society for Medical Oncology (ESMO) Congress 2024, held in Barcelona, Spain, on 13–17 September gathered top experts and researchers to discuss the latest advances in cancer treatment. This year's congress spotlighted several significant updates in lymphoma care, particularly for relapsed and refractory cases, with novel therapeutic strategies, such as advanced radiotherapy for indolent non-Hodgkin lymphoma and new combination therapies for aggressive T-cell and classical Hodgkin lymphomas, poised to influence clinical practice.

Professor Andrés Ferreri (IRCCS San Raffaele Scientific Institute, Milan, Italy) shares key lymphoma takeaways from ESMO 2024, focusing on the merging of technology and oncohaematology. View transcript.

Hypofractionated low-dose radiotherapy for iNHL

Results of a multicentre phase 2 trial showed that hypofractionated low-dose radiotherapy achieved an excellent complete response (CR) rate in patients with indolent non-Hodgkin lymphoma (iNHL). Presented by Xinue Wang (National Cancer Centre, Beijing, China), the study enrolled 73 patients and delivered involved-site radiotherapy at 12 Gy in four fractions over 1 week. It also evaluated the effectiveness of a dose-deescalated hypofractionated regimen.

Early results demonstrated promising anti-tumour efficacy, with a CR rate of 94.5% and a partial response of 5.5%, while no patients experienced stable disease, giving an overall response rate (ORR) of 100% at 6 months. Toxicities were minimal, with eight cases of grade 3 lymphocytopenia among the haematological adverse events, and no grade 3 non-haematological events, suggesting that this novel radiotherapy approach may offer a favourable balance between efficacy and safety for people with iNHL. Further follow-up is needed to assess long-term outcomes and immune response markers.

What were the most impactful data to come out of ESMO 2024? Watch Professor Andrés Ferreri discuss advances in radiation therapy and CAR-T innovation for patients with lymphoma. View transcript.

Real-world efficacy and safety of tisagenlecleucel in R/R FL

Tisagenlecleucel (tisa-cel), a CAR T-cell therapy, has shown remarkable efficacy in treating relapsed or refractory (R/R) follicular lymphoma (FL) in the phase 2 ELARA clinical trial. Loïc Ysebaert (Centre Henri Becquerel, Rouen, France) presented new real-world data from the French DESCAR-T registry that provided further insight into its performance outside the clinical trial setting.

Among 115 patients who received tisa-cel through an early access program, the ORR was an impressive 98.3%, with a CR rate of 85.8%. The 12-month progression-free survival (PFS) and overall survival (OS) rates were 62.6% and 84.9%, respectively, with a median follow-up of 9.8 months. Notably, less than 1% of patients experienced severe cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome.

These real-world findings confirm the efficacy and safety observed in the ELARA trial, demonstrating the potential of tisa-cel as a reliable option for people with R/R FL.

Professor Andrés Ferreri presents new safety strategies in CAR T-cell therapy shared at ESMO 2024, including strategies to reduce cytokine release syndrome in patients with lymphoma. View transcript.

Adding chidamide to mitoxantrone liposome in R/R PTCL

A study presented by Zhiming Li (University Cancer Center, Guangzhou, China) tackled the challenge of treating R/R peripheral T-cell lymphoma (PTCL), a notoriously aggressive cancer without an established standard of care. The researchers prescribed a regimen of combined mitoxantrone hydrochloride liposome (PLM60) and chidamide (CHI), hypothesising it would improve outcomes for patients with R/R PTCL.

This phase 1/2 trial evaluated the safety and efficacy of a PLM60-CHI combination treatment, using a dose of 20 mg/m² of PLM60 with 20 mg of chidamide. At the data cutoff, the objective response rate was 75% for eight patients in phase 2, with 37.5% achieving a CR. Overall, in 16 patients across both study phases, the ORR was 56.3%, with a CR rate of 31.3%.

Notably, no dose-limiting toxicities were reported, and while common grade 3/4 adverse events included neutropenia (66.7%) and leukopenia (52.4%), the safety profile remained manageable.

Though the median PFS and OS have yet to be determined, these early results indicate significant potential for the PLM60-CHI regimen in treating relapsed or refractory PTCL

Professor Andrés Ferreri discusses emerging lymphoma therapies presented at ESMO 2024, including innovative vaccine strategies for T-cell lymphoma using Epstein–Barr virus modification. View transcript.

Timdarpacept and tislelizumab in anti-PD-1 failed cHL

In a phase 2 study, timdarpacept (IMM01) in combination with tislelizumab showed promising results in patients with R/R classical Hodgkin lymphoma (cHL) for whom at least two prior anti-PD-1 treatments had failed. Timdarpacept, a recombinant signal regulatory protein α / immunoglobulin G1-Fc fusion protein, works by activating macrophages to enhance anti-tumour activity. Presented by Yuqin Song (Peking University Cancer Hospital & Institute, Beijing, China), this study aimed to evaluate the safety and efficacy of a novel treatment combination in a patient population with limited options.

As of the March 2024 data cutoff, 33 patients were enrolled, with a median follow-up of just over 7 months. The combination therapy demonstrated an ORR of 66.7%, with 24.2% of patients achieving a CR. Notably, the disease control rate was 93.9%, and the median time to response was just 1.6 months. While all patients experienced some form of treatment-related adverse events (TRAEs), including decreased white blood cells (54.5%) and anaemia (39.4%), the safety profile remained manageable, with no TRAEs leading to treatment discontinuation or death.

These results suggest that timdarpacept, when combined with tislelizumab, offers a promising new therapeutic option for patients with cHL who have exhausted previous anti-PD-1 therapies. Further analysis on PFS and other secondary endpoints is ongoing.

Timdarpacept in combination with tislelizumab demonstrated robust anti-tumour efficacy in patients with cHL for whom prior anti-PD-1 therapies were ineffective, while maintaining an acceptable safety profile