Tp53 (17p13.2)

[ANA4]

How effective is Ibrutinib with Rituximab (6 rounds) for a Tp53 deletion.

[lankisterguy Volunteer]

Hi Ami4,

I am not certain I understand your question completely. There have been many clinical trials since 2012 on Ibrutinib, some with Rituximab and nearly all included CLL patients with 17p deletion and / or TP 53 deletions. Those conditions are often described as "high risk".

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At each of the annual ASH and ASCO conferences for the last few years there have been papers presented that included results for Ibrutinib used for patients with many different historys and genetic criteria, here is a summary from the 2019 ASH meeting last December, along with some examples of the papers :

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hematologyandoncology.net/s...

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ashpublications.org/blood/a...

SNIP Rituximab added to ibrutinib in relapsed and treatment-naive high-risk patients with CLL failed to show improvement in progression-free survival.

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Patients treated with ibrutinib plus rituximab reached their remissions faster and achieved significantly lower residual disease levels.

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ashpublications.org/blood/a...

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Len

[ANA4 in reply to lankisterguy]

Hi Len, thank you so much for your detailed and helpful information. Your reply is highly appreciated.

[Noham027 in reply to lankisterguy]

Hello Len,

I'm currently reading many posts as my mom should begin a treatement tomorrow (ritux + imbruvica and then probably in september ritux+veneto during 15/24months with Hope to reach umrd - she is 17p unmutated- .)

Not sure about the ritux when I read the paper on the link you posted...

I feel it is not necessary to add ritux... But I also read it can help to reach remission...

May I please ask you what do you think? What is your opinion ?

Thank in advance for your response

Noham

[lankisterguy Volunteer in reply to Noham027]

Hi Noham027,-

I see you are in Belgium, and I would like to help, but please remember that I have NO medical training, so my opinion should not be used. Following your mom's doctor's opinions is important. I just try to relay my own experiences and the opinions of experts that I read. I can only suggest questions or discussions to ask of the medical team caring for your Mom, anything else would be inappropriate.

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Rituxan mono was my first treatment, and combined with Idelalisib / Zydelig for my second. In each case it caused my Lymph# to decline quickly, much faster than other patients. And it seems that when used with other combinations it helps patients quickly reach MRD - U (Minimal Residual Disease - UnMeasurable / UnDetectable). And if the objective is a specific duration of treatment, some doctors will use it as part of a 3 drug combination.

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My own CLL expert doctor usually prefers to use one drug like Ibrutinb or Venetoclax for continuous treatment. He also has observed that using Ibrutinib first and adding Venetoclax later may have a synergistic effect that can get to a better MRD-U.

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So bottom line- you should ask your Mom's doctors about what is the objective of the treatment plan and what clinical trial results are guiding their treatment sequence. Also, ask what are the contingency plans if your Mom has a undesirable side effect from Rituxan or Ibrutinib.

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Len

[Noham027 in reply to lankisterguy]

I'm aware you're not a 'doctor' but really appreciate your response anyway... So thank you very much.

The objective of the treatment plan is to reach umrd.

what clinical trial results are guiding their treatment sequence ? - I was not convinced about the response but Dr said It will be more effective to work with both (ritux & imbruvica)... But when I read the link you shared... It is not sure it will work...

the contingency plans if undesirable side effect from Rituxan or Ibrutinib : venetoclax (sept) or bone marrow transplant... Have to confirme once again.

What I do not understand or is strange to me is that only with taking Medrol (cortisol) the little nodes (biggest was 2cm) decreased... Talking about beginning a treatement comes on the table because the redblood cells decreased to 10,5g/dL...

I think I will cancel the session in the hospital tomorrow... Feel not convinced/confortable at all... But in the other hand i'm not a doctor... I do not know much on this disease... Still Reading/tryin understand things

... So perhaps should I trust with close eyes the Doctor.... And stop to check everything the Dr says...

[Noham027 in reply to Noham027]

Perhaps I was not clear... But the Dr's strategy is to begin with imbruvica/ritux and then swith to veneto+ritux (because veneto will only be refundable in sept not yet now )

[Canuck901]

How about Ibruntnib obinituzimab and Venetoclax is good or the ultra V is good combo

Or acalabrutnib obinituzimab and Venetoclax

[17Pisme]

I was in the original trial with Ibrutinib/Rituxin at MDA and all went well for 41/2 years. Unfortunately Ibrutinib began to run out of gas , which is expected with 17P/TP53 markers. So far Venetoclax/Rituxin has been great for the past 2 years but it too will probably run out of gas and then onto the next miracle drug (hopefully).

[Ana111 in reply to 17Pisme]

Thank you for your reply, I will check that with my doctor

[Canuck901]

Personally I would want the best treatment for a durable remission to give a time limited therapy and go off the drugs for a while

For me I wouldn’t want a forever pill as it will have long term side effects