Chemotherapy vs Ibrutinib for CLL Frontline Treatment - Dr Susan O'Brien. 12 to 24% of FCR patients effectively cured 6 years after FCR

[AussieNeil]

Anyone interested in the pros and cons of chemotherapy vs non-chemotherapy treatment should watch this 10 minute video by Dr Susan O’Brien, MD, University of California Irvine Medical Center, where 'she discusses frontline treatment options for patients with newly diagnosed chronic lymphocytic leukemia (CLL). In order to provide personalized therapy for patients, certain factors may determine whether chemotherapy or ibrutinib would be the more appropriate option.

Dr. O’Brien also discusses novel agents approved as second-line therapies for CLL and side effect profiles physicians should consider when recommending treatment.'

cancernetwork.com/videos-he...

The key 'certain factor' is your CLL IGHV mutational status. As Dr O'Brien notes from around the 2 minute mark, there are three publications (from the USA, Germany and Italy) within the last year showing remarkably consistent long term survival for about 60% of those with CLL IGHV mutational status. Basically if you survive for more than six years, long term survival can extend to at least 16 years (which is as far as FCR data goes back). Dr O'Brien estimates that this translates to around 60% of the estimated 20 to 40% of patients with mutated IGHV CLL now being treated with FCR are likely to experience long term survival on this chemoimmunotherapy - they are effectively cured!

Image above is Figure 2 from the German paper referenced by Dr O'Brien: Long-term Remissions After FCR chemoimmunotherapy In Previously Untreated Patients with CLL - CLL8 Trial, Updated Results:

bloodjournal.org/content/12...

Note how the top curve, showing the probability of progression free survival for patients with mutated IGHV flattens out after 72 months. In other words none of the ~67 patients surviving 6 years died from their CLL in the following 2 years. (Nearly 60% of the 113 FCR treated patients with IGHV works out at 67 long term survivors with indefinite remission.)

Neil

[Hoffy]

The results for Mutated low risk CLL patients are very good. I think it is very important that Doctors explain the risks of secondary cancers from the FCR though. I only know 1 person who had FCR 17 years ago and now he has a secondary bone cancer.

Personally my original Doctor was pushing hard to have me to FCR and talking about the risks of Ibruvica - before he found out I was 17P delete. Then after he found I was 17P deleted he did not make a big deal about Imbruvica risk.

I personally think many doctors would much rather do FCR in their clinics than give a prescription for Imbruvica. I see this as a growing conflict of interest.

Patients must educate themselves!!

[nkferg in reply to Hoffy]

I am 45 and fit, the first hem/onc doc I saw (city of 40,000) wanted me to do BR as "people tolerate it well." After doing some research, I had to ask for the IGHV test (unmutated.) She still wanted to do BR. Apparently it is twice the cost of FCR. Her office runs their own infusion clinic. She was either not up on CLL or had a conflict, I no longer go there.

[Hoffy in reply to nkferg]

Interesting. It's likely was the conflict of interest

[wroxham-gb]

Thanks Neil.

A very good video and well worth saving. WhichI have.

Hope you are over your long journey now.

Best wishes.

Sue

[Graham2222]

Encouraging and informative video - thank you.

[moon21]

Hi, I know this is an old post but does anyone have the clip saved ? As the link I longer works . Thanks