There were only 31 patience on the imbruvica group in blue. This group had mutated and unmutated patients combined. Two were 17 P deleted as well. Unfortunately one of the 17p patients progressed after 4 months but the other I think has not progressed. A few people came off the trial for other reasons . This was discussed a bit in the webinar and I pulled this from other papers.
The treatment naïve FCR groups are broken down in the graph by mutated and unmutated
This was not a clinical trial but a combination of graphs from historical data. They admit it is not very scientific.
There are clinical trials going on now investigating this exact question. I think the flare trial in England is one of them.
Fortunately CLL is a slow-moving disease so it is hard to gather data quickly. As you can see even after six years with Imbruvica the whole picture is still developing.
I have the Power point presentation. I can change it to a PDF and up load it somewhere if you want for the group. Any idea where I should up loaded it? If not I could probably figure something out
Probably best making it available to anyone interested via PM requests to you as you have offered elsewhere. Given enough demand and if copyright permissions permit, it's possible a copy could be provided on the cllsupport.org.uk website.
It would be great if there were more patients in the study. 31 makes each patient worth 3.22%. It looks like only 3 patients progressed at 6 years and I believe the last one he said came off for non CLL reasons.
It would be nice if the larger treatment centers released their non-study numbers.
For me it is the graph on ibrutinib PFS in the relapsed setting. Only 40% remain at ~years, while 90% remain that used it front line. I think there is push back on imbruvica first line only due to cost. I am hoping when the 2nd gen BTKi drugs come out the competition will drive down the price.
Well I wish we could fast forward 10 years and see if the Ibrutinib group hopefully still looks as good! Thats probably my treatment of choice coming up...unmutated del11. Thanks for the post.
Thanks Huffy. The slide shows that CLL patients who are unmutated have low long term survival with FCR; mutated patients do much better, although not as well as with ibrutinib. The evidence is clear - in Canada, oncologists need to routinely check mutational status before starting treatment, and provincial funders should cover ibrutinib for unmutated patients. This will save many lives.
Is cost the reason certain provinces in Canada have been slow to adopt the small molecule oral CLL treatments? There is certainly enough scientific evidence to support their efficacy.
How fast the process goes, is totally up to the drug companies... they initiate Health Canada approval for a drug, then if they feel there is a market in managed healthcare, they apply to CADTH, to have the drug reviewed... Once drugs are HC approved, they are often available under private coverage, and sometimes SAP compassionate access, but it varies.
It goes through a length review process, then if the comittee feels there is an unmet need or the drug is superior, then they make their funding recommendations to the provinces. If the recommendation is positive, the the provinces enter into price negotiations with the drug company, and hopefully the drug is funded.
I'm on imbruvica as first line with Rituxan. I've just finished my 4th treatment. I did treatment 1xweekly for 4 weeks now I go to 1x monthly for next 11 months. I am taking 3 capsules daily of imbruvica. My swollen neck nodes are totally unpalatable on left side and barely palatable on the right. Largest was 3 cm by 3cm before treatment. I also had multiple swollen nodes in all areas of neck, auxiliary, and sub centimeter in lungs. My bone marrow was 73% lymphocytes as well. My nodal biopsy on 1/16/17 gave diagnosis of SLL. I'm stage IV. My oncologist at MDA feels I have decades to live as I am 51 with no other health issues. My dr offered FCR and BR as treatment options as well.
Fortunatley I am on a Clinical Trial out of UC San Diego combining Ibruvica and Venetoclax. They start with I for 3 months then add in V. I have been on I for 2 months. So Far so good. No major side effects and my nodes and counts are way down! And both drugs are covered by the trial. This trial is in many other cities too - I am told
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Dr. John Allan - Chronic Lymphocytic Leukemia (CLL) Patients @Undetectable Measurable Residual Disease (MRD) after Ibrutinib Plus Venetoclax
Unmutated CLL and MRD-
