Treatment Postponed

[Estate1]

Saw my Hemo/Onco today and she postponed my first BR for a week and prescribed antibiotic to deal with ear infection. Good plan...

[Newdawn Administrator]

Sounds like a wise move Estate and I know the Trial I’m waiting to get into won’t start treatment if there’s a current infection.

Hope you feel better soon and all goes well with the BR.

Newdawn

[Newdawn Administrator]

Incidentally Estate, are you happy to leave your posts ‘unlocked’ meaning they can find their way onto the internet?

As you have a photo avatar, it may be wise to edit them and tick the ‘community only’ box to protect your identity.

Regards,

Newdawn

[Estate1 in reply to Newdawn]

Thanks for the heads up. I’ll make that change.

[Hoffy]

Is Imbruvica possible in Canada? Any possible clinical trials?

Be well,

Hoffy

[Estate1 in reply to Hoffy]

Imbruvica is available in Canada, but pricey I gather...

“Ibrutinib, marketed as Imbruvica by its manufacturer Janssen Inc., was approved for use by Health Canada late last year. The list price for Imbruvica is believed to be somewhere around $100 per capsule.Feb 29, 2016”

[Hoffy]

Any clinical trials? Are you near the US?

Recent studies at ASH 2018 you might have seen already:

mdedge.com/hematology-oncol...

Expense is can be a major issue though.

Do you know if you are Mutated or Unmutated ?

Have they checked your CLL genetics?

If you are unmutated Imbruvica could be better.

You can find good information on the CLL Society web site.

cllsociety.org

Be well,

Hoffy

[Estate1 in reply to Hoffy]

Thanks Hoffy. Can’t afford to go outside Canada. BR is a reliable protocol and it’s all covered by govt health care.

[Hoffy]

OK, Imbruvica should be covered in Canada in about 2 years or less I am told. I know that does not help you now...

Many times the drug companies help one pay a lot of the cost as well now - I am told,

Be well,

Hoffy

[Cllcanada Top Poster CURE Hero in reply to Hoffy]

Imbruvica (ibrutinib) is funded NOW in nearly all provinces , however restrictions apply first line.

Its funded everywhere second line...

Perhaps Estate1 does not meet the requirements...Hoffy.

There are no copays in most provinces in Canada..100% payment, perhaps a dispensing fee but it varies by province...

~chris 🇨🇦

[Hoffy]

Interesting. Do you think he could start with just Rituximab or Gazyva to start then if he relapses use imbruvica as 2nd line?

This way he could avoid the cytotoxic "B" in BR per the 2018 ASH paper .

onclive.com/conference-cove...

I know UC San Diego many times just gives Gazyva to patients.

Thanks for all the on going help!!

Be well,

Hoffy

[Cllcanada Top Poster CURE Hero in reply to Hoffy]

I have no idea.. very unlikely ... protocols require GC, as far as I'm aware... I have no idea of his local, doctor's experience etc... genetics, and so on..

Imbruvica (ibrutinib) is cytotoxic... all CLL treatments are, they kill B cells.

~chris 🇨🇦

[Hoffy in reply to Cllcanada]

Does Imbruvica do DNA damage like " Bendamustine" does? Imbruvica is blocking the BTK.

blog.dana-farber.org/insigh...

Thanks!

Hoffy

[Cllcanada Top Poster CURE Hero in reply to Hoffy]

Well ibrutinib shuts down signals... and the B cells die... but the B cells sometimes figure away around this and mutate a gene, where the Imbruvica (ibrutinib) binds and Imbruvica (ibrutinib) can,t work any longer... so patients becone refractory. Its not common, but it certainly occurs.

Bendamustine induces extensive and durable double-stranded DNA breaks in cloning B cells that result in initiation of the p53-dependent stress response and apoptosis of the B cells.

It is very well targeted I have no idea where people get the idea it causes wide DNA damage...its B cells and they die.

Bendamustine is somewhat like cyclophosphamide with a purine analog ring, that is still not fully understood, but its a bit like fludarabine... so generally Bendamustine is FC...

Its been used in the former Soviet Union for over 30 years, but only came to the west recently...

~chris 🇨🇦

[Estate1 in reply to Cllcanada]

Very technical stuff! I’m just getting my feet wet and I appreciate the discussion.

[Cllcanada Top Poster CURE Hero in reply to Estate1]

What province?

[Estate1 in reply to Cllcanada]

Alberta. I asked Onc/Hemo about ibrutinib here and she said BR is first line treatment.