While your reference was a good guide to the revolution in CLL treatments two years ago, developments have continued apace since then. For example, your reference concludes "Based on the high rate of deep responses and long remission durations combined with good tolerability, venetoclax-based combinations with BTK inhibitors or triple combinations are very likely the future of CLL treatment; however, the approaches are still experimental and require more clinical data before adapted in general practice."
I've just reported the extremely impressive outcomes in the first report on a limited time combination therapy treatment of venetoclax combined with acalabrutinib and obinutuzumab here: healthunlocked.com/cllsuppo...
I'm also maintaining a list of approved and clinical trial drugs in this post and one of my replies to that post: healthunlocked.com/cllsuppo...
When I was diagnosed nearly 13 years ago, there had been a long period of little innovation in the treatment of CLL, with FCR just starting its long run as the gold standard CLL treatment, a badge it still holds in most countries. Problem was it was a tough treatment for those over 65. That was particularly challenging for most of us, given the median age for a CLL diagnosis was in your early 70s, with the median time to treatment about 5 years further on. Hence the new "non chemo" combination treatments promise very long remissions - and without the ~10% risk of a secondary cancer of AML or a struggling bone marow (MDS), to so many more of us.
The downside is that the cost of these new treatment drugs means that countries with universal health care (which is most of the world), struggle to make them available. Where they are approved, you generally can only gain access to them if you have unfavourable markers or have previously had treatment with an older "chemo" treatment.
The positive of living in one of the countries yet to approve these new treatments and being a member of this community, is that you can use the knowledge of the improved outcomes learned here to advocate for approval of them. You can also learn that they may be available to you, simply by asking for a second opinion from a CLL specialist, rather than your conveniently located, but less CLL experienced local oncologist/haematologist.
Neil I neglected to say, "less CLL experienced local oncologist/hematologist" was right on the money. Also, I joined this site for many of the reasons that you pointed out. As cajunjeff said: Very well put Neil.
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