Brielle Benyon

The investigational drug glofitamab showed promising outcomes in patients with relapsed/refractory B-cell non-Hodgkin lymphoma (B-NHL), according to results from a phase 1 study published in 

These early findings show that glofitamab may end up being a more attractive option for this group of patients than other currently available CAR-T cell therapies.

“Glofitamab is an available and accessible ‘off-the-shelf’ T-cell–engaging therapy. These properties contrast with those of current CAR-T cell therapies, which require manufacturing, may require bridging therapy, and may not be feasible in patients with rapidly progressive disease,” the study authors wrote.

The trial — which analyzed potential dosing strategies and safety for the drug — included 171 pretreated patients with B-NHL: 90.6% were refractory to prior therapy, with the average amount of prior therapies being three. About three-fourths (74.3%) had diffuse large B-cell lymphoma, transformed follicular lymphoma or other aggressive histology, and the rest of the patients had indolent lymphoma subtypes.

The trial was divided into two parts. Part 1 assessed glofitamab’s efficacy at 0.005 milligrams, 0.015 milligrams, and 0.045 milligrams, but there were no responses at that dose, and all patients withdrew because their disease got worse.

Part 2, however, had better responses, with drug effects starting at the 0.6 milligram dose. At the 25-milligram dose, all patients reported cytokine release syndrome (CRS), so the researchers found that this exceeded the maximum tolerated dose for one day. As a result, moving forward, the researchers established two step-up dosing groups: 2.5 milligrams on cycle 1 day one and 10 milligrams on cycle 1 day 8, then either 16 milligrams or 30 milligrams on cycle 2 day 1. The 30 milligram-dose was decided to be the dose moving forward in phase 2 trials.

Nearly half of patients (49.3%) with aggressive B-NHL had a complete response (CR) – meaning that there was no detectable cancer in their bodies – when given a 10 milligram-dose or higher.

“CRs were achieved rapidly in patient’s high tumor burden, bulky disease, and refractoriness to multiple therapies,” the study authors wrote.

Nearly all (98.2%) of the patients experienced one or more side effect from glofitamab, with the most common being CRS, occurring in 50.3% of patients. A total of 21.5% of CRS was grade 1; 25.1% grade 2; 2.3% grade 3; and 1.2% grade 4.

“CRS was manageable with low rates of grade 3 or higher and moderate use of steroids or tocilizumab with no treatment withdrawals,” the authors wrote. “Events fully resolved in all but one patient who died because of progressive disease before recovery.”

As patients continued to be treated, the number who experienced CRS decreased – 13.1% in cycle 2 and 6.1% in cycle 3 or later. Patients with high disease burden or bone marrow infiltration were more likely to experience CRS.

More research still needs to be done, but for now, glofitamab is showing promising results.

“Glofitamab has demonstrated frequent, durable CRs and a manageable tolerability profile and allows off-the-shelf treatment for patients with refractory B-NHL in need of timely therapy,” the authors concluded.

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Early findings show that glofitamab may be a safe and effective option for patients with pretreated, relapsed/refractory B-cell non-Hodgkin lymphoma.

Investigational Drug Shows Promise in Lymphoma Subsets

The National Comprehensive Cancer Network states that palliative care can — and should — begin at the point of diagnosis for patients with cancer. Often confused with hospice, or end-of-life-care, palliative care focuses on managing distressing symptoms, from psychosocial issues to side effects, and can be used regardless of a patient’s cancer stage or prognosis.

Despite the well-documented advantages of palliative care, it is still underutilized in cancer centers around the United States (U.S.), according to recent study results published in 

READ MORE: What is Palliative Care? Top 4 Questions Answered

“Patients are living longer with better therapeutics, so there are a lot of people who are doing pretty well, but they have a lot of distress and side effects from treatment,” said study author Dr. David Hui, an associate professor in the department of palliative care and rehabilitation at The University of Texas MD Anderson Cancer Center, in an interview with 

Hui and his colleagues analyzed palliative care educational programs for health care providers at 52 National Cancer Institute (NCI)-designated cancer centers and 27 non-designated cancer centers across the U.S. The team also looked at changes in palliative care education and research between 2009 and 2018.

Ultimately, they found that NCI-designated cancer centers were far more likely to have palliative care fellowships, training programs and research for palliative care. Across the board, changes and improvements in palliative care programs were slow at best.

“The take home message, I think is that the glass is half full and half empty,” Hui said. “There has been some progress, but in my mind, I feel that it’s still inadequate, and much more needs to be done.”

Hui mentioned that much funding is spent on the development of new cancer therapies. However, palliative care may be able to boost the effectiveness of these new treatments, ultimately leading to better outcomes.

“Fundraising is still very much focused on cure more so than care, perhaps. I recognize that both of them are important,” Hui said. “In fact, I will argue that palliative care can hopefully help to improve the chances of patients getting through their cancer treatments (and) tolerate them better. So they are truly hand-in-hand.”

Hui said that it is important for researchers and palliative care advocates to educate patients, clinicians, hospital leaders and policymakers about the importance of palliative care. In doing so, he hopes to see an eventual increase in palliative care training for health care providers, and an uptake in its usage by patients.

One major stigma to overcome is the confusion between palliative care and hospice — the former can be used alongside treatment, regardless of disease stage or prognosis, while the latter is specifically for end-of-life care.

At MD Anderson, Hui said that the outpatient palliative care center had its name changed to supportive care.

“We found that actually helped to reduce the stigma from the perspective of the referral clinicians,” Hui said. “They feel much more comfortable talking about this term and getting patients involved, even though the program is the same.”

Hui explained that this type of care can be seen as preventative care in many ways. It provides symptom education early on, teaches patients how to use their medicine and avoid pain crisis and emergency room visits.

“Rather than preventing a fire, we are putting out a fire to begin with,” Hui said.

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Progress on palliative care education and adoption in cancer centers has been slow, but an expert from The University of Texas MD Anderson Cancer Center says studies show that it can improve cancer outcomes.

Cure and Care Go Hand-in-Hand: Expert Discusses the Importance of Palliative Care in Cancer Treatment

Cancer survivors can use the power of mindfulness to build resiliency and decrease the stress and anxiety that often accompanies a diagnosis, says Loren Winters, a nurse practitioner at Massachusetts General Hospital Cancer Center in Boston.

Winters – who presented on this topic at 

®’s Educated Patient® Breast Cancer Summit – recently spoke with 

® and discussed the benefits of mindfulness, as well as some tips that patients can use before an anxiety-provoking procedure.

Can you give an overview of mindfulness and resiliency, and how they’re related?

 Mindfulness is essentially a tool amongst many to build resilience …. It is an Eastern concept, an Eastern practice that goes back probably thousands of years and, and here in the West, we've adopted it more recently, but in big ways.

When I started here in oncology, a lot of people didn't know really what yoga was, or understand it, or could cancer patients do it? And now, there's a plethora of options that exist both through medical centers in there if they have an integrative therapies program, like we do, but also out there in the community. And now of course, virtually in droves. So the access has been viral, which is really great.

There's a lot of options in terms of doing mindfulness practices. And I think this idea of resiliency is just started to emerge, I don't think people quite still grasp what that is. But if you ask someone to describe someone they know, that is very resilient, they can easily do that. So it's sort of trying to put that together. Now, it's not just about mindfulness, but it's also about how you take care of yourself like the basics, sleep, good food, exercise, being with others who are building you up, that kind of thing.

What are the benefits of mindfulness for cancer survivors?

Mindfulness, in essence, teaches one to be fully present in whatever moment that's happening. So it may be good, it may be bad. It might have a label, but whatever that moment is, (it is) what it is. To be (mindful is to be) fully present, to be fully aware of what's going on without judging it without attaching a story – it is incredibly powerful.

Once one is diagnosed with cancer (it can) go from zero to 60, very fast. You know, there's a huge fear of mortality … fear of recurrence in our survivors. But you know, it's not what's actually happening right now, the storyline can balloon and get very big, and that can create a lot of anxiety. As we know, anxiety, and depression are very common in cancer survivors and cancer patients.

I really like that that RAIN mnemonic that I used in my presentation: Recognize what am I feeling right now? What's going on? And then you sort of go through naming it, then looking inward: what do I need right now? Maybe I'm exhausted, maybe that's part of why I'm going in 1,000 directions, and then just pulling it back to, “Oops, sorry (that) this keeps happening.”

So I think in that realm, (mindfulness) can be very effective, as well as even prior to procedures and blood draws. Having a little mini (mindfulness practice) that one might do before going into an anxiety-provoking or even a pain-provoking procedure can be effective and can take the edge off whatever's going on in that moment.

When is the best time to introduce mindfulness in the cancer journey?

Frankly, I wish it could start as early as screening and diagnosis. But what I found, even though we have all these wonderful resources, (and that patients) could enroll in a resiliency training program right off the bat, it’s too much all at once for most folks. Maybe there's a couple that might do that. But in most (cases), they need to go at their own pace; they need to come to it when they're ready. And not everybody wants it, but those that do, I think (are) seekers (and) they're looking for this stuff. And maybe their provider suggests it and (the patient says they) would like to learn these tools.

I haven't had a patient yet who's come back and said, “That was a waste of time.” It's like, “Whoa, I can really use tools like these, that was really helpful.” Again, it's about when and where, and who, but if it's something (they’re) open to, it can be very beneficial.

For more news on cancer updates, research and education, don’t forget to 

An expert from the Massachusetts General Hospital Cancer Center recently spoke with CURE® and discussed how mindfulness can benefit cancer survivors.

Mindfulness Can Decrease Anxiety and Build Resiliency in Cancer Survivors

Cancer survivors and caregivers alike can use the practice of mindfulness to build resilience, and there are plenty of resources available that can guide users through the process, according to Loren Winters.

Winters, an oncology nurse practitioner and associate director of breast cancer survivorship at Massachusetts General Hospital (MGH) Cancer Center in Boston, recently discussed mindfulness and resilience at 

®’s Educated Patient® Breast Cancer Summit.

“In a nutshell, mindfulness is paying attention on purpose. It’s not necessarily about filling or clearing the mind, but it’s about being present simply to what is,” Winters said, noting that this is often more difficult that it seems, since people are conditioned to be in a stress state. People are often in what’s called a “fight-or-flight” response, which can have negative impacts on health.

Chronic stress can result in physical issues, from headaches and fatigue to anxiety, productivity loss, and unhealthy coping behaviors. However, as there is a stress response, there is also a relaxation response, Winters explained.

“Contrary to the stress response, which occurs subconsciously, the relaxation response needs to be consciously activated, and it requires practice,” Winters said. She cited the work of Dr. Herbert Benson, a cardiologist who described the relaxation response as the common effect of mindfulness practices, including yoga, meditation and deep religious prayer. Benson found that this practice has health benefits, especially for people with high blood pressure.

 that patients and their family members can access anywhere, anytime.

By taking 15 to 20 minutes each day to focus on mindfulness – be it through a guided exercise, or by relaxing the body and focusing on a mantra (a repeated word or phrase) – individuals can activate the parasympathetic nervous system, which can cause “a cascade effect on body systems,” Winters said.

“In fact, research (in) measuring brain activity has shown that mindfulness and relaxation practices can actually strengthen certain parts of the brain that are responsible for these important functions: deliberate control decision-making, memory, awareness, and perception, depending on which method is being used,” Winters said.

Mindfulness can also benefit the cardiovascular and gastrointestinal systems, reduce inflammation, improve cell immunity, release tension, and improve mental health and its related issues, such as anxiety and sleep problems in patients with cancer, according to Winters.

In her presentation, Winters offered five tips on how people can build their mindfulness “muscle.” They are:

Work with a trainer, be it a mindfulness teacher, through a class or app, or with a book.

Increase reps, meaning gradually increasing the amount of time spent doing mindfulness exercises, working up to a daily practice.

Build practice into everyday activities. This can be through something simple, like taking a few moments to do a body scan, taking inventory of how each body part feels, from your head to your toes.

Through mindfulness practice, cancer survivors can build their resilience, which is defined as, “the ability of the body to recover from or easily adjust to misfortune or change.”

“So for cancer survivors, use of coping skills led to an opportunity for personal growth or positive adaptation,” Winters said, citing research that analyzed resilience in patients with cancer.

“Mindfulness and resilience are more easily cultivated with simple strategies that can be practiced in everyday life,” Winters concluded.

Mindfulness practices have been associated with improved mental health outcomes in patients with cancer. Here, an expert shares tips on how patients can strengthen their “mindfulness muscle.”

Brielle Benyon

Investigational Drug Shows Promise in Lymphoma Subsets

Cure and Care Go Hand-in-Hand: Expert Discusses the Importance of Palliative Care in Cancer Treatment

Mindfulness Can Decrease Anxiety and Build Resiliency in Cancer Survivors

How Patients With Cancer Can Boost Their ‘Mindfulness Muscle’ and Improve Resiliency

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