FCR vrs Ibrutinib front line

When I hear DRs say they would rather use FCR than Ibrutinib front line because there might be a chance for a cure, I wonder are those that are considered cured free of all the other toxic effects of FCR? I also wonder if using Ibrutinib first would necessarily rule out FCR and the possibility of a cure second line? Anybody know or care to guess?


20 Replies

  • Hi johnl,

    I'm hazarding a guess here, but FCR can offer longer remission, as it stands, because Ibrutinib hasn't been "out there" long enough to compare. Some doctors and patients who have seen no relapse after FCR after ten years are starting to use the word cure. I think this is where it is coming from. Ibrutinib is still in its infancy as a treatment, relatively speaking.




  • Yes and the FCR...10+ years cured, is a very small group of younger Type 1, 13q:14, mutated patients with no other adverse markers... the full scope of what sets these patients apart is being looked at.


  • Chris:

    Is it a small group of 13q:14 patients or a small group of FCR patients in general? and what is considered younger? I wish someone would put some numbers on these statements if they want you to decide


  • Hi John

    This is just what I have picked up from various comments, Dr. Weirda has discussed this in a few interviews on Patient Power... etc...

    This is not a treatment protocol...more observational.


    Dr. Sharman also includes Trisomy 12 patients...


  • Thanks Chris


  • Also it's a different regime!

    Currently ibrutinib means continued use of the medication whilst FCR is a six cycle ( or less) treatment usually. It's also been around so long term records are available in respect of remission etc.

    Yes FCR could affect the long term situation regarding your immune system but remissions of 10 years plus are worth this risk. The risks of ibrutinib are only just being  documented and long term use may bring further effects yet unknown. It's the same with all new drugs,of course.

    The decision medics have to make alongside their patient is what gives the best chance without major side effects.

  • If I had had the right markers, I would have gone with FCR for all the reasons Cammie has mentioned.

  • I have viewed many many bookmarked videos (Patient Power, ONCLive, etc- let me know if you want all the links)  where CLL experts like Dr. Furman debate this subject with Dr. Keating or Dr. Lamanna.  In general Dr. Furman is opposed to Chemo for nearly every patient, since he believes it does irreparable damage.  Dr. Keating cites certain groups of patients with Mutated 13q or Mutated Tri 12 that remain in remission for more than 10 years after FCR. 

    I suggest that you get input from one or more informed CLL experts, after they thoroughly examine your genetic markers and physical condition, and then decide which side of the debate fits your own situation.  

    Len  (Corrected 4/29- to say MUTATED)

  • Hi Len,

    Yes, please provide the links, because the group of patients that have long remissions and possibly a cure are a much larger group than those you cite with 'UNMutated 13q or UNMutated Tri 12'.   From the first paragraph of the Discussion section in the paper originally published in Blood on 22nd October 2015 and available online from there and NIH: ncbi.nlm.nih.gov/pubmed/264... entitled Fludarabine, cyclophosphamide, and rituximab treatment achieves long-term disease-free survival in IGHV-mutated chronic lymphocytic leukemia by authors Philip A. Thompson, Constantine S. Tam, Susan M. O’Brien, William G. Wierda, Francesco Stingo, William Plunkett, Susan C. Smith, Hagop M. Kantarjian, Emil J. Freireich,  and Michael J. Keating, I quote: 'In our series, patients with IGHV-M had a highly favorable outcome following primary therapy with FCR, with a plateau on the PFS curve, and persistent MRD-negativity in all long-term survivors who were tested. In contrast, there were few long-term disease-free survivors among patients with IGHV-UM, who have a median PFS of only 4.2 years; only 9 of 126 patients with IGHV-UM remained in clinical remission beyond 10 years. The difference in PFS translated into a significant survival advantage for patients with IGHV-M. IGHV-M and IGHV-UM are of course IGHV-Mutated and IGHV-Unmutated respectively.'

    Interestingly, I couldn't find a reference to Trisomy 12 or del 13q patients in that paper - whether IGVH mutated or unmutated.



  • Sorry Neil,   I meant to write 13q Mutated and Tri 12 Mutated as the patients likely to get long remissions.  I posted some of the videos below- but the data is from MD Anderson- Dr. Keating and was presented at CLL Live 2015 - the link is provided below, along with several other mentions by Dr. Lamanna and Dr. Byrd. 

  • While I fit in the favorable group (but getting close on the age limit 63). I've been W&W for 14 yrs and seen too many patients having problems after FCR, even those in long remissions, to feel good about going that route. Maybe I spend too much time on ACOR


  • Hi John,

    You need to take into account that patients that sail through FCR treatment have nothing to post about..

    I don't know what the ratio is for online forums but when it comes to bad vs good experiences with a product or service, a rule of thumb is that 10 people with a bad experience will complain to others, for every person who mentions a good experience.

    With CLL treatments, our best guidance comes from statistics reported in clinical trials.


  • A specific comparison video for the pros & cons of FCR vs. the newer agents is from CLL Live 2015 in Niagara Falls by Dr. Michael Keating (widely recognized as the godfather of FCR). This long and detailed video contains tons of specific data, it may require multiple viewings and research since it is very technical but extremely useful:     preview.tinyurl.com/jru2nbd 

    A much simpler explanation from Dr. Furman (my doctor and like me,- opposed to the use of FCR except when no other alternatives are possible):  onclive.com/insights/b-cell... 

    Dr. Furman believes that Chemo increases the risk of 2nd cancers and really dangerous transformations/side effects like Richter's, MDS,  

    A counterpoint from Dr. Lamanna- from CLL Live 2015  starting around 30 minutes into the 47 minute presentation:   preview.tinyurl.com/jc8rpx2 

    John Byrd also addresses this debate, favoring FCR for patients that are Mutated 13q or Tri 12 due to the long Progression Free Survival starting at 20 minutes into this 52 minute presentation: event.webcasts.com/viewer/e... 

    Here is a panel discussion where Dr. Kipps, Dr. Byrd and Dr. Furman debate the FCR vs. Ibrutinib for the Mutated 13q & Tri 12 : preview.tinyurl.com/zjvxrjb 

  • Hi I'm 46 been on w and w for 5 years. Fatigue and bulky nodes are forcing me to go for treatment. Health otherwise is good. I'm never sick not even with a cold. Signed up for clinical trial but unfortunately pulled FCR arm and not Ibrutinib. I'm not 17p deleted and waiting to find out if I am mutated. Dr pushing for me to take FCR which I will do if I am mutated. In the UK so Ibrutinib not an option for front line therapy. Any ideas what I can do instead of FCR if I am unmutated?

  • Hi Kenn123,

    I am not medically trained but from what I read: If you are 13q mutated or Trisomy 12 mutated, you could get a very long remission from FCR. If your tests come back unmutated or any of the other deletions - see:


    from: oncology.jamanetwork.com/ar...

    you may want to look for a clinical trial on Venetoclax, which I read is currently recruiting at several major centers in the UK.

    I'm currently on Venetoclax after failing Idelalisib and Ibrutinib and doing great. There are several other posters here from the UK on Venetoclax trials including debinoz a writer from Australia who commutes to London for her trial.


  • Thanks for that. I'll look into it now. It's a bit nail biting waiting to find out what I am.

  • If you have been told to take fcr it's still a very good option. It's hard but 70 percent get at least five years to next treatment So you can have some years of normal life at least

  • Hi Len... hard to think we were in Niagara Falls almost exactly a year ago... 

    For some reason I'm not getting any videos...just an error message and black screen


  • Hi Chris,

    HU is still doing strange things with hyper links to youtube, I tried to edit and get only the hyper link, but HU inserts the video,  so I put in TinyURLs with the preview feature to allow you to vett the link before opening. 


  • I'm not seeing that problem Len.. just make certain there is nothing after the You Tube letters in the URL...in this case it is 5wrtLA8UOhM

    If the link is good you will get the first screen image as above...

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