Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

CAR T induced resistance in ALL

Ruella M et al. Nat Med. 2018 Oct 1. doi: 10.1038/s41591-018-0201-9

Key clinical point: Unintentional transduction of a single leukemic B cell induced resistance to CTL019 (tisagenlecleucel) therapy.

Major finding: A patient with B-cell acute lymphoblastic leukemia (B-ALL) had frank relapse 9 months after a CTL019 infusion, with more than 90% bone marrow infiltration of chimeric antigen receptor–transduced B-cell leukemia cells.

Study details: A case study of a 20-year-old male with B-ALL undergoing CTL019 therapy.

Disclosures: Study funding was provided by Bristol-Myers Squibb, Novartis, the National Institutes of Health, and others. Dr. Ruella and several of his colleagues work under a research collaboration involving the University of Pennsylvania and the Novartis Institutes of Biomedical Research and are inventors of intellectual property licensed by the University of Pennsylvania to Novartis.

Read the article here.


Ruella M et al. Nat Med. 2018 Oct 1. doi: 10.1038/s41591-018-0201-9.

This Week's Must Reads

Broad opioid legislation advances in Congress, Senate floor debate, Sept. 17, 2018

Early supportive care cuts costs related to curative treatment, Koprowski CD et al. 2018 ASCO Quality Care Symposium, Abstract 142

Employee deductibles outstrip wages, Kaiser Family Foundation, 2018 Employer Health Benefits

The financial burden of metastatic breast cancer, Wheeler SB et al. Quality Care Symposium, Abstract 32

Must Reads in Immuno-oncology

CAR T induced resistance in ALL, Ruella M et al. Nat Med. 2018 Oct 1. doi: 10.1038/s41591-018-0201-9

Refractory esophagogastric cancer: Nivolumab plus ipilimumab ups response rate , Janjigian YY et al. J Clin Oncol. 2018 Aug 15. doi: 10.1200/JCO.2017.76.6212.

Baseline steroid use may decrease efficacy of checkpoint inhibitors, Arbour KC et al. J Clin Oncol. 2018 Aug 20. doi: 10.1200/JCO.2018.79.0006.

Nivolumab plus ipilimumab ups survival in melanoma patients with brain mets, Tawbi HA et al. N Engl J Med. 2018 Aug 23. doi: 10.1056/NEJMoa1805453

Safety, efficacy of third-line avelumab assessed for gastric cancer, Bang YJ et al. Ann Oncol. 2018 Jul 24. doi:10.1093/annonc/mdy264.