"In today's CLL climate, web informed patients are rebelling against FCR - and in many cases, I think it is for good reason. FCR is a tough regimen. Even in the German CLL8 study, about 4% of patients die in the first 12 months after starting therapy. In the MD Anderson data set, it appears that unusual infections are increased as far out as two years from therapy. The long term risk of marrow compromise and secondary cancers is real.
But.... In appropriately selected patients, it is probably all worth it
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I think these subgroups (IgVH mutated WITH either Trisomy 12, or Del 13Q) have high likelihood of super long term disease control if not cure.
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For patients with CLL who need therapy, it is imperative to test for FISH and for anyone considering intensive chemoimmunotherapy - IgHV mutation analysis is a must. For patients less than age 65 with IgHV mutated CLL and either trisomy 12 or del 13Q, should seriously consider FCR as these groups have exceptionally high rates of progression free survival (like about 90% and I believe many of these will prove to be cured)." (My emphasis.)
Yes I'm pro FCR if you can tolerate the treatment - I didn't have the best progostic markers (I'm del 6q and unmutated) but even with those and only 3 cycles it bought me 2 and a half treatment free years and I keep meeting people who have not had treatment since they did FCR 15 years ago - that is definitely worth a little bit of pain!
I totally agree...it is still the gold standard firstline... for a particular group of patients... certainly not everyone... but for some... and we are beginning to better define that group.
It makes me sad when I see people with good prognostic markers being so adamant that they want to avoid chemo that they subject themselves to novel therapies which all have side effects, daily ongoing treatment and the reminder they have CLL which might not buy them half the remission that FCR would. I too was afraid of chemo but our disease already plays havoc with our Cytogenetics so people's fear about future secondary cancers or clonal evolution are equally valid if they don't have chemo. I know I harp on about it but I worked full time throughout FCR and had 3 children under 8 to look after with all the germs which come with that and I had a really smooth run - if you can tolerate it I really wouldn't go past the gold standard. My Drs only ended up persuading me to have it because they said they would know so much more about my disease by its response to FCR and to be honest I just got too sick and there wasn't anything else available to me in Australia. I'm so pleased I had it and yes I relapsed earlier than I hoped but what a great 2 and a half years of wellness I've had (and we now know my disease is aggressive!).
Nice catch on Dr Sharman's new blog post. It's wonderful to see him post again. I read everything that he writes in addition to Dr Koffman and Andrew Schorr.
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