Georgetown Lombardi Comprehensive Cancer researchers have found that patients with follicular lymphoma (FL), a slow growing lymphatic-system cancer, who have been treated and are in remission for at least two years, may no longer have what has been considered an incurable disease. The team has come to this conclusion based on highly sensitive testing powered by Seattle-based Adaptive Biotechnologies—and this implies that some of these patients may not need therapy or active follow-up.
Follicular lymphoma accounts for about 33% of all non-Hodgkin’s lymphomas. In the United States, at least 20,000 people are diagnosed with the disease annually. It is a cancer that involves certain types of white blood cells known as lymphocytes. The cancer originates from the uncontrolled division of specific types of B-cells known as centrocytes and centroblasts. Normally occupying the follicles in the germinal centers of lymphoid tissues such as lymph nodes, the cancerous cells in FL typically form follicular-like structures in the tissues they invade. It is these structures that represent the dominant histological feature of this cancer.
Although not the most aggressive forms of cancer, FL patients experience a high rate of disease recurrence and are often exposed to different therapies. It is considered an incurable disease; however, the recent study may reveal that, in fact, for some patients it is cured.
The Pilot Study
Medstar Georgetown University Hospital and Georgetown Lombardi investigators enrolled 68 patients with follicular lymphoma at the Georgetown center. Each patient had undergone conventional treatments for the disease and had been in clinical remission for over two years. Twenty-five patients had biopsy samples that did not meet the study criteria, therefore only 43 patient samples were able to be fully assessed, reported Georgetown Lombardi in a press release.
The team first examined patient biopsy samples from the time of their initial diagnosis for changes in their lymphoma cells with next generation sequencing tests. These powerful tests now have the ability to detect minute genetic alterations that are specific to FL. Second, the team evaluated each of the patient’s blood to detect possible remaining lymphoma cells by searching for specific genetic changes identified in the original biopsy samples. Of note, out of 43 patients with next-generation sequencing, 38 had no evidence of lymphoma in their blood.
An Important First Step
This test marks important progress for FL patients. The ability to detect which patients might be disease-free and might not need treatment anymore is important as many of these patients had undergone numerous therapies—often due to multiple relapses. They were always concerned about the possibility of a relapse.
A pilot study with a limited number of patients and a relatively short period of time but as one of the investigators, Dr. Sarraf Yazdy noted the study lifted the “psychological burden these patients faced with a diagnoses of a presumed incurable disease.” Hence, an exciting discovery but there is lots of work to do in the form of a larger study—“this is an important first step,” commented Dr. Yazdy.
Adaptive Biotechnologies Participation
Adaptive Biotechnologies actively participated in this pilot study. Based in Seattle, WA, they are a pioneer and leader in immune-driven medicine aiming to improve people’s lives by learning from the wisdom of their adaptive immune systems. They have developed a proprietary immune profiling platform and products immunoSEQ and clonoSEQ, that helps reveal and translate insights from adaptive immune systems with what they purport to be unprecedented scale and precision. Their clonoSEQ is test authorized by the FDA for detection and monitoring of minimal residual disease in patients with select blood cancers.
Founded in 2009 by brothers Chad and Harlan Robins, they are projected to lose approximately $60 million on $78 million in revenue. With a share price of $29.06, their market capitalization equals $3.6 billion as of this writing. They hold $573 million in cash. They filed their IPO May 2019 raising $230 million. They employ about 350 and have raised a total of $630 million.
They have inked deals with big players including Microsoft—which invested $45 million in the company—to develop an AI engine that can detect several diseases form a single blood test. Moreover, they inked a $300 million collaborative licensing agreement with Genentech to develop personalized cancer therapies. This Genentech deal includes up to $1.8 billion in success-driven milestone payments.
Its largest shareholders include Viking Global Entities (36%) and Matrix Capital Management (16.4%). Founder Chad Robbins still maintains 6.3%.
About Georgetown Lombardi Comprehensive Cancer Center
The Georgetown Lombardi Comprehensive Cancer Center is designated by the National Cancer Institute as a comprehensive cancer center—the only cancer center of its kind in the Washington, DC area. The center is actively involved in the quest to improve the diagnosis, treatment and prevention of cancer through innovative basic and clinical research, patient care, community education and outreach, and the training of cancer specialists of the future.
Georgetown University Medical Center (GUMC)
Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis—or “care of the whole person.” The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health.
Other authors involved include Umair Jarral, MD and Yin Chao, MD at Medstar Georgetown University Hospital/Lombardi Comprehensive Cancer Center. Frank Kuhr and Allison P Jacob at Adaptive Biotechnologies in Seattle, WA. The researchers disclose relationships with industry, which can be reviewed on the source press release for those interested.
Call to Action: For those diagnosed with Follicular Lymphoma, this reveals promising news but it is still just a first step in understanding whether remission can be permanent. TrialSite News monitors this research—sign up for the daily digest for updates.