Venetoclax -> Ibrutinib

[artkula]

I am new here and write on behalf of my father. He is 62 y/o and was diagnosed with CLL 1.5 year ago. He received BR treatment and experienced an early relapsed with del17p/Tp53. He could not afford Ibrutinib but got enrolled into a 2-year Venetoclax trial. Meanwhile, we are seeking opportunities to get Ibrutinib which is less expensive than Venetoclax. Hopefully, by the end of this 2-year period, he could get it. I saw many people describing the transition from Ibrutinib to Venetoclax and I wonder if anyone underwent an opposite transition, namely, from Venetoclax to Ibrutinib. I would appreciate if you could share your experience.

Best wishes to everyone of you!

[Hoffy]

I am on a ibruvica + Venetoclax trial, From what I can tell Venetoclax is stronger than Imbruvica. With 17P Deletion it is best to stay on Venetoclax if you can in my opinion. Maybe special funding could be given by the drug company or others some how,

Hoffy

[artkula in reply to Hoffy]

Thank you for the response, Hoffy. I hope the trial procedure will bring the best result to you.

We received conflicting statements from the doctors, one saying Imbruvica is still the best choice as a first treatment another saying that as Ibrutinib uses a different pathway, it should still work after Venetoclax and 17p deletion alone is not a major predictor of an outcome with these drugs. Things like having or not having complex karyotype, Richter transformation or Fludarabine-refractory CLL serve as better predictors.

I wonder when you tell stronger, do you mean side-effects or efficiency? From what I read, the dropout rate for Imbruvica due to side effects is greater than that with Venetoclax. That is where Acalabrutinib is a new hope since it uses the same pathway as Ibrutinib but has fewer adverse inhibitions and thus expected to yield fewer side-effects.

[Hoffy in reply to artkula]

Venetoclax is strong from an efficacy standpoint. And Side effects appear to be less. One can always start on Ibruvica or ACP-196 and move to Venetoclax later. It is unknow what is better - starting as a combo or waiting til one does not work and moving to the next drug. Both are good drugs and much better in my opinion than traditional Chemo therapy.

Be Well,

Hoffy