New Treatments

I just had my three month check up. My doctor informed me of some new and upcoming treatments. I thought I would share:

There are several new treatments that are available for the treatment of CLL. In addition to the standard chemo-immunotherapy combinations of the past (These are regimens like Fludarabine-Cytoxan-Rituxan and Bendamustine-Rituxan) there are also newer anti-CD20 monoclonal antibodies with a drug called Gazyva (obinutuzumab). There are three “newer” oral targeted drugs for CLL therapy. Ibrutinib and Idelalisib have been out for a few years and help to block different areas of the b-cell receptor. The newest FDA approved medication (approved in April) is venetoclax which targets a protein called BCL-2 (This drug is not used up-front at this time as it is only FDA approved for people with a 17 p deletion). So there remains several newer options for the treatment of CLL.

These medications are typically used as single agent by themselves. (Idelalisib (Zydelig )is actually FDA approved in conjunction with 8 doses of Rituxan). Obinutuzumab is an injection which runs over about 4-6 hours.

Have any of you tried these treatments?

I hope everyone is taking care of themselves!

12 Replies

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  • Jemi

    Great news about these new drugs!

    Of course not every country is offering these like the states.

    There are patients on here who have used most of them including venetoclax either as part of a trial or with other drugs in dual therapies.

    I'm sure if you search the site you will find more info about them.

    It's very important we keep up with new therapies so thanks for the info

    Geoff

  • Thanks so much for sharing. As Cammie says, you're in America so may differ with availability but isn't it great to hear that there are new options becoming available all the time. It bring us so much hope for our futures. Thank you.

    Peggy

  • I believe in US after you fail Imbruvica or Idelalidib you will be offered venetoclax

  • Venetoclax and other approved novel agents can be used front line in non-17 deleted patients although I would consider this only if you are under the care of a CLL specialist. Not all insurances cover these agents for such patients , but some do, so worth asking your CLL specialist about. Idelalisib however should never be used front line.

  • I am just wondering why Idealisib should not be used front line?

  • Thanks Neil.

  • Idelalisib is contra indicated for first line... its not an option.

    ~chris

  • Thanks for heads up, I hope new treatments spread around the world as soon as possible

  • I am blessed to be on Ibrutinib as my first line treatment. Now I just keep my fingers crossed that it will be effective for a long time. Have to give those wonderful researchers time for the next breakthrough!

  • For the first treatment, especially for younger and more fit folks, there's a very convincing argument that chemoimmunotherapy is still the best choice over some of the newer agents, sexy as they may seem.

    The argument is that with BR or FCR for first line treatment, it's six rounds and then you're done. You'll get a remission of several years at least and perhaps longer, especially for younger mutated patients that do FCR. On the other hand, once you start one of the new targeted agents you can't really stop for the rest of your life unless you're having severe side effects and need to switch to a different one. The very long term effects of the new targeted drugs are not yet known.

    For first line treatment, and as a 65 year old fit guy, I buy the argument that six and out is the way to go. I chose BR as my first treatment, tolerated it easily, and got a remission that's holding steady. I don't have to put any drugs in my body right now. The longer my remission lasts the better -- I'm back in watch and wait until relapse occurs. When I need treatment again, there will be even better and more easily tolerated drugs than the pills now on the market.

    Other views exist, of course, but thought I'd throw mine out there.

  • The problem with chemo is the increased risk of another cancer down the road. Combinations of newer therapies are in some cases getting deep responses with MRD negativity (>50% with some therapies) and some people are then stopping therapy. A recent video by Dr Furman was posted on this site in which he said if someone wanted chemo they could "find another doctor". Everyone is different in regard to what risk they are willing to assume for potential benifit. Nothing is lost by trying the non-chemo therapies if they are available and potentially have great advantages without increasing risk of more agressive leukemias and MPN.

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