Following the recent interview of Dr. Furman (by the way, my CLL expert) with Brian on PatientPower in which he speculated on using ABT-199 after an initial treatment wtih Ibrutinib, here is an article from Medscape yesterday on ABT-199. An excerpt:
"Despite heavy previous therapy, the response rate was still 70% to 80%, and that's independent of 17p status, which is a very remarkable observation...with these very exciting new agents targeting CLL biology, we really are entering an era where chemotherapy as the mainstay of treatment can be overcome...the striking thing about ABT-199 is that, compared with [the CLL drug] ibrutinib, it leads to much more rapid cell destruction, even in high-risk CLL patients."
[Note: will need registration to Medscape which is free]
Photo: a sunset two years ago over the Atlantic Ocean from Tarifa, at the southern tip of Spain, separating the Mediterranean from the Atlantic. The sunset represents the death of chemotherapy for all of us CLL patients.
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zevkalman
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"the striking thing about ABT-199 is that, compared with [the CLL drug] ibrutinib, it leads to much more rapid cell destruction, even in high-risk CLL patients."
Absolutely. In fact, two patients died in the USA of TLS for reasons still being discussed (poor adherence to protocols or the protocol itself being weak?), but since then the protocol has been made more strict, clinical trials have been reinstituted, and there have been no other severe cases to my knowledge. See the excellent articles by Chris on this subject or the one by AussieNeil:
TLS is an adverse event seen in early trials, in fact it killed a friend of mine Randy Shirley on a massive dose increase of ABT-199. However dosages have been reduced and patients are now watched extremely carefully during the first treatments.
As Dr. Furman pointed out use of perhaps Imbruvica (ibrutinib) or and IDELA (idelalisib) first followed by ABT-199 much later, would mean the levels of lymphocytes would be quite low and TLS wouldn't be an issue with ABT-199.
'Dr. Furman:
So you would take the ibrutinib and idelalisib on day one and then on day 365 start taking the ABT-199, and there you won't have any tumor lysis to worry about because the tumor con itself will have been reduced 99 percent.
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I'm new here; question about ibrutinib and rash
NHS decision takes away Ibrutinib from patients
Ibrutinib, Acalabrutinib, or Zanubrutinib 
Coming off Ibrutinib while awaiting next treatment.
That's it then FCR here we come
