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Statistical analysis of REACH trial patients identifies Progression Free Survival prognostic factor for FCR patients

Statistical analysis of REACH trial patients identifies Progression Free Survival prognostic factor for FCR patients

Why is this news about FCR - an 'old' immunochemotherapy treatment, so important now that we have non-chemotherapy treatments like Ibrutinib and Idelalisib? Many CLL specialists recognise that for some CLL patients, FCR may be a better choice. Just 6 month's treatment and they can hopefully forget about their CLL for many years, perhaps forever!

REACH (NCT0090051) was an open-label randomized (1:1) phase III trial in relapsed CLL comparing FC with FCR, (that is comparing traditional chemotherapy using Fludarabine+Cyclophosphamide, compared to immunochemotherapy in which the monoclonal CD20 antibody Rituximab/Mabthera is added to the Fludarabine+Cyclophosphamide.) As we now know, FCR was demonstrated to significantly prolong Progression Free Survival (PFS) and most importantly Overall Survival (OS) compared with FC alone in untreated (first-line) patients as well as to improve PFS in previously treated (second-line) patients. FCR is considered the gold standard treatment for CLL, with some patients with the 'right' CLL genetic markers having a PFS in excess of 10 years and considered possibly cured.

Statistical analysis of patients enrolled in REACH has identified INPP5F expression as a prognostic factor for PFS, regardless of adjusting for treatment, age, Binet stage, IGVH mutational status, del(17p) and ECOG performance status. The researchers suggest that INPP5F may serve as a novel, easy-to-assess future prognostic biomarker for fludarabine-based therapy in CLL and "In addition, our data may also support the strategy of combining NF-κB and/or BCL-2 inhibitors to standard therapy in CLL."



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Thank you Neil. When he was recovering from 6 months of FCR, my husband experienced some very grave side effects. Now a year and a half after treatment, we are learning that we have so much to be grateful for. I don't know if he has this prognostic indicator, but his complete response and what we hope will be a long durable remission is thrilling and a blessing for our family. Thank you for this very educational post, I will share it with his oncologist who can now rightly tell me "I told you so."

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