As the coordinator of Leukaemia Foundation Australia's National CLL Telephone Forum & Blood Cancer Support Coordinator on the Mid North Coast of NSW Australia (& registered nurse) - I am a relatively infrequent contributor to CLL Health Unlocked.
However I was lucky enough to attend this years International Working Group CLL 2015 (IW CLL 2015) conference in Sydney Australia, so thought I should share my perspective on some of the highlights of this years conference for anyone who may be interested - as per below.
Many thanks everyone & please don't hesitate to post any comments or questions!
Chris Hobson / aka Daisy Ruby1 / Blood Cancer Support Coordinator / Leukaemia Foundation Australia
International Working Group CLL 2015 Highlights
•Conference opened & introduced by Hon Dame Marie Bashir following a traditional aboriginal welcoming ceremony
•Prof Max Cooper opened with a fascinating talk on the history of the B cell tracing back millions of years to prehistoric animals & the evolution of our understanding of its’ complexity in the past 50 years
•Freda Stevenson did a very impressive talk on the structure & function of the human B cell receptor
•Susan O Brien updated on Duvelisib a new P13K inhibitor (similar to Idelalisib) which is showing efficacy in clinical trials for relapsed & refractory CLL
•Highlight for Monday; a debate between Dr Clemens Wendter & Dr Tait Shanafelt entitled “Will Chemotherapy Have A Role To Play In CLL Management in 10 years?”
•Both sides of the debate spoke very convincingly for their case & a show of hands at the conclusion showed that approximately 50% of the delegates agreed & 50% disagreed with the notion….a fascinating discussion & the jury is still definitely out!
•NB: This discussion was very much the recurrent theme throughout many of the talks i.e. exactly how & in what combinations / doses with the new novel agents be used with or without the more traditional chemotherapy / immunotherapy & in what patient specific populations etc.
•Thomas Kipps & William Weirda did excellent presentations on the CLL microenvironment & the search for therapeutic treatments to target that microenvironment e.g. stromal in bone marrow cells, nurse like cells etc.
•Second highlight for Monday was a medical dinner sponsored by Roche during which x 3 doctors presented case studies on complicated / difficult to treat CLL patients & a panel of x 3 senior haematology consultants then discussed the various treatment options & approaches available & compared their advice with the presenters account of what actually unfolded in the real scenario. Very informative & insightful & I personally learned a lot about the new complexities in CLL treatment during this dinner.
•Wei Xu presented a fascinating talk on the role of the EB virus in prognosis & Hep C virus reactivation in CLL
•A great series of presentations on CLL epidemiology in Hong Kong Chinese patients, south Asian patients & CLL characteristics in Japanese patients - as CLL remains relatively rare in Asian populations Thomas Chan / Eric Tse / Colin Phipps / Jun Takizawa - also an excellent poster presentation on this subject.
•Stephen Mulligan presented on results of safety & efficacy of the CLL 5 OFOCIR trial which compared oral FC in varying doses & schedules combined with IV Mabthera in elderly previously untreated patients..... a personal highlight for me - as it was the first haematology trial I ever worked on!
•Phillip Thompson presented results of a Phase II study which assessed lenalidomide & rituximab in previously untreated CLL patients - it appears lenalidomide may possibly have a significant role to play in future treatments for certain CLL patients
•Michael Keating did an excellent talk on managing the unique toxicities of the new novel agents in elderly patients...the main known toxicities summarized very briefly below....
•Ibrutinib; Atrial Fibrillation / bleeding & bruising / diarrhea & colitis
•Idelalisib; colitis / rash / & some abnormal liver function lab values
•John Gribben spoke brilliantly about the role of "T cell exhaustion" & failure of T cell mediated immune-surveillance in the pathogenesis of CLL.
•"Funding The Equation" / Q & A Symposium moderated by Tony Jones from ABC’s Q&A discussing the complex issues & logistics of funding access to the new CLL medications in Australia, providing equity & comparing Australia's situation to that in Europe, USA & Canada.
•For me this was probably the highlight of the conference as it covered all the issues that normally come up during the CLL phone forum regarding equitable access to new medications. It was especially enlightening to hear from panellists from the pharmaceutical industry discussing the various reasons that new medications are typically so expensive, a PBAC committee member who discussed the role & workings within the committee, x 2 clinicians × 2 CLL patients - one who is a family physician & passionate patient advocate & the other an LFA board member.
•What struck me most was that despite the intense passion with which CLL patients & most clinicians - quite rightly - want the new small molecule treatments to be available to all patients, the economic & political realities of the current situation are far more complex & the government needs to consider an extremely wide range of issues & factors before subsidizing such expensive, and still relatively new medications
•Jennifer Brown’s talk on integrating the new BCR targeted therapies into current clinical practice was absolutely excellent & for me summarized what essentially felt to be the general consensus of the meeting.....i.e....that whilst the new BCR targeted therapies & new generation of CD20 antibodies have certainly revolutionized the treatment landscape & available options for relapsed or refractory patients & / or those with poor prognostic markers & aggressive CLL at diagnosis & improved outcomes dramatically, there still remains some significant issues around their incorporation into wider clinical practice worldwide.
•Some of these potential issues include...
•Using them in the best possible dose & combination with other existing therapies & work continues globally on refining evidence around best possible dosing & combination therapies in order to establish new standards of care.
•Possible issues with long term patient compliance in taking oral medications lifelong as opposed to undergoing 4-6 cycles of chemo immunotherapy only.
•Massive cost in supplying these very expensive medications lifelong to large numbers in the community, possibly partially offset by a potential reduction in CLL related hospitalizations, complications & mortality.
•Relatively short term data available on long term adverse events related to BCR & small molecule inhibitors & a need to establish consistent guidelines on adverse event management related to their use