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Thread: Blinatumomab a bispecific antibody

  1. #1
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    Blinatumomab a bispecific antibody

    I am wondering if anybody had this antibody and what was your experience.
    66y female, dx @43 in 1992 - DLBCL (aggressive lymphoma) CHOP x 6, rads x 20. 2007- Follicular Lymphoma (FL) grade1-2, stage 2, rads x 20. 2013 relapsed FL, grade 1-2, stage 4. R-bendamustine x 6. Finished Jan 2015. Rituxan maintenance till 2017. 11/2014 bladder cancer, surgery end of Jan 2015.

  2. #2
    Moderator Top User IndyLou's Avatar
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    Hello-

    Blinatumomab is the molecule name for Blincyto, the branded name for an immunotherapy treatment. It's primarily used to treat acute lymphoblastic leukemia (ALL.)

    Here's a thread I found on this forum. User @abeucher has a husband who has received the treatment, and is doing generally very well in remission.

    https://www.cancerforums.net/threads...light=blincyto
    Age 54 Male
    early Feb, 2013 - Noticed almond-sized lump in shaving area, right side of neck. No other "classic" cancer symptoms
    late Feb, 2013 - Visited PCP for check-up, PCP advised as lymphoma. Did blood work, orders for CT-scan, referred to ENT
    3/7/13 - CT-scan inconclusive, endoscopy negative
    3/9/13 - FNA of neck mass
    3/14/13 - Received dx of squamous-cell carcinoma, unknown primary
    3/25/13 - CT-PET scan reveals no other active tumors
    3/26/13 - work/up for IMRT
    4/1/13 - W1, D1 of weekly cetuximab
    4/8/13 - W1, D1 of IMRT
    5/20/13 - complete 8 week regimen of weekly cetuximab
    5/24/13 - Complete 35-day regimen of daily IMRT
    mid-July 2013 - CT-PET scan reveals no active tumors, but shows necrotic tissue at site of original tumor
    early Sept 2013 - partial neck dissection to remove necrotic tissue. Assay shows no cancer present.
    Spring 2014 - No signs of cancer
    Spring 2015 - NED
    Spring 2016 - NED
    Spring 2017 - NED
    Spring 2018 - NED
    Spring 2019 - NED

  3. #3
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    Thanks. Why is it not used for lymphoma?
    I see that experience with it is very limited.
    Last edited by fighterm; 07-09-2019 at 09:04 PM.

  4. #4
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    Hi,

    There have been clinical trials (phase 1 and 2, as far as I know) in the past couple of years for Blinatumomab in lymphoma patients. It seems somewhat promising. You might want to ask your hematologist if you could benefit from any such trial in your area.

    One tentative answer to your question may be: cost. When it was approved in 2014, Blinatumomab was said to be the most expensive cancer drug ever.

    PBL
    Last edited by PBL; 07-10-2019 at 08:51 AM. Reason: addendum
    06/2015 - Spontaneous pelvic fracture after 8 years of unexplained left hip pain
    02/2016 - 52 y.o. - Final Dx: Grade 2, Stage 4 Primary Bone Follicular lymphoma
    TTT - 6 R-CHOP21 (03-06/2016) + Maintenance Rituximab (08/2016-04/2018.)
    Currently in remission - Semestrial scans+mris & follow-up appointments with hematologist.

  5. #5
    Super Moderator Top User po18guy's Avatar
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    On the subject of monoclonal antibodies, I received two infusions of Ofatumumab (Arzerra) to control GvHD. Over two years later, I am still B Cell depleted. Pretty potent stuff. From the Wiki:

    "Ofatumumab[1] (trade name Arzerra, also known as HuMax-CD20) is a fully human monoclonal antibody to CD20, which appears to inhibit early-stage B lymphocyte activation. It is FDA approved for treating chronic lymphocytic leukemia that is refractory to fludarabine and alemtuzumab (Campath) and has also shown potential in treating follicular lymphoma, diffuse large B cell lymphoma, rheumatoid arthritis and relapsing remitting multiple sclerosis. Ofatumumab has also received conditional approval in Europe for the treatment of refractory chronic lymphocytic leukemia."

  6. #6
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    PBL, good answer. I was comparing it to car T cells which are even more expensive.

  7. #7
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    Po18, blinto is not just a usual antibody. It's bispecific. It binds to cd19 on a lymphoma cell and also binds via the second arm to CD3 on T cell. This way it brings cytotoxic T cells to lymphoma cells and that is the mechanism of bispecific antibodies. They can bring activated cytotoxic T cells to any cancer by redirecting T cells to the target on cancer cells. There are also trifunctional bispecific antibodies. They have the constant domain like normal antibodies which is recognized by macrophages and other immune cells. Bispecific antibodies do not have the constant domain.

  8. #8
    Super Moderator Top User po18guy's Avatar
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    Understood. Obviously, I have been out of the loop for some time. Good and bad, actually.

  9. #9
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    Have any bispecifics been tried in follicular lymphoma?

  10. #10
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    "Expert opinion: The recent approval of blinatumomab for B-ALL symbolizes a breakthrough for BiTE technology with prospective application in the targeted therapy of other cancers. Although blinatumomab seems an unlikely option for treating indolent lymphoma due to toxicity, the need for long-term continuous infusion therapy and multiple promising well-tolerated oral agents, it holds promise for aggressive NHL patients whose diseases are refractory to current standard approaches." (in https://www.tandfonline.com/doi/abs/...nalCode=ieid20)

    Those things are so potent that the major issue with them is neurologic toxicity (esp. encephalopathy...). Using them on indolent lymphomas could be compared to getting a wrecking ball to kill a mosquito...
    Last edited by PBL; 07-12-2019 at 07:26 AM.
    06/2015 - Spontaneous pelvic fracture after 8 years of unexplained left hip pain
    02/2016 - 52 y.o. - Final Dx: Grade 2, Stage 4 Primary Bone Follicular lymphoma
    TTT - 6 R-CHOP21 (03-06/2016) + Maintenance Rituximab (08/2016-04/2018.)
    Currently in remission - Semestrial scans+mris & follow-up appointments with hematologist.

 

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