New Clinical Trial of Ibrutinib + Venetoclax for people relapsing on Ibrutinib

[Teegolf47]

Yesterday I started a new clinical trial at UCSD for people that have relapsed on Ibrutinib. I had been a part of the RESONATE trial and have been on Ibrutinib for 4 1/2 years. Early this year began a trend of increasing ALC and enlarging lymph nodes. A next Gen Sequencing test showed a mutation in the C481S gene, confirming that eventually Ibrutinib alone will become ineffective. This trial is trying to determine if by adding Venetoclax, it will block additional pathways and may event delete the C481S mutation making Ibrutinib effective once again. In untreated patients the trials have shown that there is synergy in combining Ibrutinib + Venetoclax. So the hope is that even in heavily pre treated, complex karyotype (I am both of these) that there still will be a response. The main problem with this trial for those of us with Medicare Part D, is that I am responsible for the Venetoclax co-pay, which will be about $10,000 for this year. The Ibrutinib will be paid for in the trial. I know this sounds crazy for a trial, but the main reason is that they are going to test a non-standard dosage of Ibrutinib, while the Venetoclax dose is the standard 400mg dose. Hence, Venetoclax is considered 'standard of care' for relapsed with a 17p deletion. No issues so far, but I am only on day 2. But I have never been so hydrated. I am considered 'low risk', so doing the standard 5 week ramp up of the Venetoclax to get to 400 mg. More to come.

Terry Evans

[Cllcanada Top Poster CURE Hero]

Very interesting, and thank you for your participation in a clinical trial...

I look forward to hearing more in the future...

~chris

[DaleFL in reply to Cllcanada]

Is venetoclax being used for people without 17p deletion in US?

[Cllcanada Top Poster CURE Hero in reply to DaleFL]

I have known a few who have been able to access it 'off label', usually 3-4 line. It should be more readily available this year in the U.S. second line, in combination with rituxan... I think it's in the FDA... at the moment for this indication...

~chris

[DebKat999 in reply to Cllcanada]

May I ask someone to please define what "off label" exactly means? I am assuming I understand what everyone means here, but just thought I would ask to be sure.

[Teegolf47 in reply to DebKat999]

Once a drug has been FDA approved for a condition it usually is for a specific disease and/or condition. For example. Venetoclax was approved for CLL patients that have had one prior therapy and have 17p deletion. Once it is approved a physician can write a script for other situations like a relapsed patient with 11q or a treatment naive patient with 17p. Or actually any condition. The hurdle now would be to get the insurance company to pay for the drug ‘off label’. Sometimes the will approve it, sometimes not. If you are rich you could just pay for it yourself and skip the insurance hassles.

[DebKat999 in reply to Teegolf47]

Thanks so much for this explanation. I can understand how this type of access to certain drugs is extremely important for some people. In the future it could possibly be very important for me as well, only time will tell.

[Teegolf47 in reply to DaleFL]

I agree with Chris, it would be 'off label' and usually the justification written by one of the top CLL docs like, Furman, Kipps, O'Brien, Byrd, etc. They have been known to work miracles when it comes to getting approval for non FDA approved therapies.

[Jm954 Administrator]

It’s an interesting hypothesis that they are testing and sounds hopeful.

I hope things go well for you, please keep us updated.

[cllady01 Former Volunteer]

What won't they think of next to not pay for our Cancer treatment?

I hope things go well for you and that this is your ticket to stop both meds. and have a long remission.

I suspect the new tax laws that have messed with our coverage and saved the government and insurance companies money.

I just read the following, which affects personal income tax filings, is in the new tax laws.

Repealed: A credit for 50% of the cost of clinical testing of drugs for rare diseases and conditions.

Repealed: The deduction for medical expenses exceeding 7.5% of adjusted gross income has been repealed. Supposedly, to allow a tax code that lowers insurance rates every year for the rest of your life.

I don't know if the new law, just signed today that allows any new drugs in the pipeline working to be approved to be used for those in terminal situation who want to try them, is because of the repealing of the first mentioned repeal.

[CADreamer in reply to cllady01]

According to a summary online of the tax changes for 2018 tax year, individuals can claim medical expenses over 7.5 percent of adjusted gross income. It appears the law did not repeal but did modify. The previous law was you could only claim medical expenses over 7.5 percent if you were 65 or over. Otherwise the ceiling was 10 percent for everyone else.

[Redlion]

Hi Terry, It is good to see that there are trials taking place for post Ibrutinib treatment and I wish every success for you and the trial. I had my baseline CT scan today in preparation for my imminent Ibrutinib treatment, I am also TP53/17P mutated, been on W&W for the last 8 years. I have a strange mixture relief and apprehension as I approach this new phase of my journey but I know that I am very fortunate to have this treatment for 1st line treatment. Best wishes.

[annmcgowan]

Thanks for the post very interesting. Hope all continues to go well for you.

Ann

[ontheblock]

What is dose

Of ibrutinib they are using?

[Teegolf47 in reply to ontheblock]

The first cohort of 3 patients will be at 420mg, then every additional cohort increases the Ibrutinib dose by 140mg up to a max of 840mg

[ontheblock in reply to Teegolf47]

Interesting concept. It’s going to take two years to learn whether all of the patients now failing on ibrutinib should stay on it while Venetoclax is introduced In meantime It maybe wise to stay on ibrutinib for those not in trial at usual dose until study is completed. Is there a no ibrutinib arm to see if none is same as ibrutinib arms? Sure would help knowing whether the benefits outway the costs involved for both drugs on Part D 20$k/yr

[Teegolf47 in reply to ontheblock]

Since one of the requirements of the trial is that you are relapsing on Ibrutinib, there is no arm of Ibrutinib only. It makes sense to create a trial for those people that are still responding to Ibrutinib and add Venetoclax to see if they can get to MRD- status. But I don’t know if any like that yet.

[fell]

I’m on a treatment naive trial for I/V and also in the midst of the ramp up phase. I’m on week three at 100 mg. This sounds like a very interesting trial and I wish you all the best!

[lankisterguy Volunteer]

Hi Teegolf47,

You may want to ask your CLL expert doctor that is running the trial to go to bat for you with Genentech Venclexta Foundation [phone]

Dr. Furman's staff did the paperwork and I have been getting Venclexta since June 2016 at no cost, no charge to my insurance. They just called me yesterday, reviewed my case and approved me for the 3rd year.

I am Trisomy 12 UnMutated so it's a "Off Label" prescription from Dr. Furman.

PM me if you want the name and email of Dr. Furman's PA that wrangled the paperwork.

Len