In his latest blog, Dr Sharman compares treatment improvements in HIV and prostate cancer with the current developments in CLL & NHL treatments and notes that sequential single agent therapy creates sequential mechanisms of resistance.
He observes that there have already been at least four cases of ibrutinib resistance and argues the case that a combined drug treatment will be necessary to avoid CLL/NHL developing resistance to new treatments.
Finally Dr Sharman joins others in musing that with the new small molecule drugs, based on the assumption that a lower tumour burden reduces the chance of resistance developing, perhaps we should reconsider when to treat CLL?
I'm eagerly awaiting his mooted future topic on death by neglect (of CLL cells), where he'll cover how ibrutinib and idelalisib flush CLL cells out of the bone marrow and lymph nodes into the peripheral blood where they die from lack of microenvironment stimulation i.e. "from neglect". Wouldn't it be wonderful to be in the same league as those with CML and have access to a drug that can keep the symptoms of CLL at bay and give us back our quality of life, rather than having to stay in watch and wait?
As Dr Sharman says, right now "there is more reason for optimism than ever before", but we still need to work out an effective way to stop CLL from developing resistance if we are to find a cure AND we have to make it affordable.
While a long post, it is well worth reading.