The future of CLL therapy we believe will include fixed duration treatments of non-chemo drugs. In this interview from EHA 2019, Dr. Peter Hillman discusses one of the most promising, Venetoclax and Obinutuzumab. See cllsociety.org/2019/11/eha-...
At EHA 2019, Dr. Ghia presented the data that should lead to the approval of acalabrutinib in relapsed/refractory CLL, discussed the end of chemo, and the need for a CLL expert. See: cllsociety.org/2019/11/eha-...
Thanks.
Stay strong
Brian (CLLSociety.org)
Written by
bkoffman
CLL CURE Hero
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That’s amazing! Glad to hear it. My hubby is 17p deleted. In my gut I was glad he didn’t have to go through the chemo. He is doing well on his trial of Keytruda and Ibrutinib. Age 72.
Not many if one have choices. Young healthy mutated patients with other good prognostics have a shot of some 15 years or longer of no disease after 6 months of FCR. I do not recommend BR.
This is the decision I'm faced with if V+O isn't approved in Germany - Ibrutinib, which could essentially leave me stuck in a foreign country for years (because insurance), or FCR, which could cause other damage.
Chemo destroys the bad and all the good so it’s tough to rebuild after that , people are now getting better responses from the oral combinations. Only problem is these trials are still in progress and won’t be standardized for a few more years
My main concern is that chemo doesn't work in most CLL patients in term of improving overall survival. If it did as it does in other cancers such as testicular cancer and many others, I would be more willing to consider it.
But I thought that for a significant % of younger mutated patients FCR is providing 10 years or more remission, some are even saying cure? How is that not improving overall survival?
That is maybe true for about 15% of patients. For those young healthy low risk patients with no bad markers, there is about a 50% chance of very durable remissions that looks a lot like a cure. It is a worthy consideration. For the other 85%, the odds are not nearly as good, still FCR does overall improve OS in CLL. That is why it is considered the gold standard but we have now proven that we can do better with the novel agents. If considering CIT, you need to see which group you belong to as the statistical OS benefit of chemo to a significant extent comes from the excellent responses of a minority of patients. If you are over 65, or have co-morbidities, or are unmutated or del 11q or 17p or mutated TP53, you have much better choices in my opinion, at least in the USA. FCR doesn't help many of us and it increases the risk of 2nd cancers in all of us. We have even less data about OS with BR and other CIT. Lots of ways to look at the data. Not everyone agrees with me.
Perhaps adding Acalabrutinib or Ibrutinib or Duvelisib to FCR makes senses for the right patients. Maybe the best of both world, but only time will tell. Early results are very promising.
My husband is an ideal FCR candidate on paper but our hope is we are avoiding unnecessary toxicity by taking the also time limited I+O+V combo route. Only time will tell but we’re amazed 9 months in that he pops daily pills and goes on with life like nothing is wrong. Grateful for these new options and the awesome drs and researchers and early trial participants who brought them to us.
I’m on the Ohio State clinical trial with A+O+V. Having the 17p/TP53 unmutated, I’m thrilled with the results so far. I’ve heard that others on this trial are doing well too. So glad research is finding new meds that are helping CLL patients!
As bizarre as this sounds, I'm glad to have CLL in this amazing time. Obviously the diagnosis of cancer sucks. A lot. It took a lot of time to come to terms with it. Somedays are still a struggle.
But with all of the advancements and the inevitable cure, we are so very fortunate.
Great news! I'm (fingers crossed, this is dependent on the German government's upcoming decision) slated for V+O in the coming months, and I couldn't be happier about it after everything I've read.
Which combo do you think has the most promise? V+O or I+V
Also, can you explain how that chemo doesn’t improve overall survival? Surely one survives longer with treatment rather than not Did you mean compared to the small molecules?
OS and PFS are more improved with Ibrutinib versus BR or FCR. It is more nuanced than that, but that us the bottom line. I have a lot of this on our website.
FCR does improve OS compared to no treatment, but the benefit from Ibrutinib is much better. Not sure if BR has been proven to improve OS.
Both are great options. In my opinion, I+V will probably prove to be the best in terms of PFS and OS, though that is far from proven at this point. Also if I+V doesn't work or one relapses quickly, options are more limited.
Year long protocol with Venetoclax and Rituximab at Seattle Cancer Care Alliance and am doing amazingly well. Very happy with the treatment.
Have you seen any research on what happens if one becomes MRD - before the year is up? Is there any risk of damaging healthy cells if there is no cancer to work on?
I have noticed some folks in the 6-8 month periods start to report more effects such as neutropenia and pneumonia. Any research on when, during treatment, side effects are most likely to show up?
It is an unanswered question with VR if the best treatment is to treat until U-MRD or treat for a fixed duration. The first seems more logical, but we need to prove that it is the best choice. With FCR, it is the depth of remission that determines the duration of response. Also, the longer one is on a med, the greater the risk of side effects.
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Results on triple combination (A+V+O) for high risk patients -with-chronic-lymphocytic-leukemia-or-small-lymphocytic-lymphoma-cll
EHA 2022: Outcomes Following Treatment With a Covalent BTK and BCL2 Inhibitor
