Then and now: A renaissance in blood cancer treatment

Just a decade or two ago, a person diagnosed with blood cancer faced a narrow path forward: chemotherapy, radiation, perhaps a bone marrow transplant. Treatment delivered in a hospital setting, with 5-year survival rates hanging in the teens.

Flash forward to today, where scientific innovation has greatly changed the treatment landscape for blood cancer, driven primarily by targeted therapies that disrupt cancer cell growth and survival.

Five-year survival rates for leukemia alone have nearly doubled from 34 percent in the mid-1970s to 66 percent in the early-mid 2000s, according to the Leukemia & Lymphoma Society.

Treatment changes in the past 10 years alone have proven life-changing for one person with chronic lymphocytic leukemia (CLL). At his time of diagnosis over a decade ago, Ben Greenlee’s doctor did something that may seem counterintuitive: He told Ben not to treat his blood cancer.

“He said, ‘Well, we don’t really have options now, but by the time you need it, there’ll be better options out there,’” Greenlee says. “Which didn’t sound as hopeful as he meant it, it felt like a death sentence.”

As it turns out, Greenlee’s doctor was indeed correct and now Ben has the right treatment plan.

While great strides have occurred, cancer researchers are motivated to continue advancing science for those with more aggressive and difficult to treat diseases, according to Steve Davidsen, Ph.D., vice president, oncology discovery research, AbbVie.

“The field of oncology is really in a renaissance time right now,” he says. “We’re making progress and slowly chipping away, but there is still a ton of unmet need and work ahead of us.”

Most blood cancers start in the bone marrow, where they affect how blood cells are produced and function. Blood cancers are represented by 3 main types: leukemia, lymphoma and myeloma, with over 100 subtypes.

In acute myeloid leukemia (AML), for example, cancer starts in the bone marrow. It most often develops from cells that would eventually become white blood cells. In another leukemia, chronic lymphocytic leukemia (CLL), cancer develops within a specific type of white blood cell called B cells.

The longtime standard of care for blood cancer, chemotherapy, wipes out not only cancer cells but also other healthy cells. This challenge prompted researchers studying both blood cancers and solid tumors to find ways to target only cancer cells

AbbVie’s unique strategy and emphasis on cellular biology is what led to uncovering a new field of regulated cell death in certain leukemias, Davidsen says.

“We look at mechanisms that are essential for cancer cells to survive and propagate, and that may take us to hematological malignancies or to solid tumors,” he says. “It’s a matter of being tenacious so we can reveal the really interesting molecules.”

Tenacity is also reflected in the approach of AbbVie’s clinical team, once they advance a molecule along its journey to becoming a medicine, according to Jalaja Potluri, M.D., executive medical director, AbbVie.

A hematologist-oncologist by training, Potluri and her team are focused on designing trials in areas of unmet medical need, sometimes rare cancers with little existing treatment options. Persistence is key in advancing trials, because these patients can’t wait, Potluri says. One project her team worked on went from the clinical program to approved medication in 4 years, a process that can typically take 10 years or more.

“Being a leukemia doctor, I can’t say enough how exhilarating that experience was,” Potluri says. “We were able to impact a disease with many sub-types and great unmet medical need.”

New technologies and approaches have accelerated the pace of science, enabling the development of novel therapies in blood cancer that have the potential to be game-changing to patients, according to fellow AbbVie executive medical director Jim Dean

“A greater understanding of disease and investment in laboratory research helps us design more efficient clinical trials and get new treatments to patients faster,” he says. “The science fiction of my childhood is science reality today.”

Scientists are driven to increase understanding even further, bolstered by innovation in genetics and genomics as well as precision medicine, Davidsen says. For example, scientists can now dig deeper in the genetic differences between subsets of people with a particular type of cancer, which can help identify a tailored approach.

More advancements are on this horizon with both antibody and cell-based therapies along with what Davidsen calls the next generation of agents that cause cancer cells to undergo alternative forms of regulated cell death.

“The science can take you down so many paths you didn’t even think about,” he says. “That’s what gets us up in the morning – you begin to think of new science and new possibilities for patients.”