EHA 2022: Outcomes Following Treatment With a Covalent BTK and BCL2 Inhibitor

[Lavinia-Blue]

cllsociety.org/2022/08/eha-...

"Conclusion:

Double exposed patients with CLL/SLL don’t do well, as proved by these rather grim statistics on time to next treatment discontinuation, duration of the subsequent therapy, and overall survival. The authors conclude, and we wholeheartedly agree: “There remains a need for more effective therapies for patients with CLL/SLL after progression on cBTKi/BCL2i“."

[peacethruthestorm]

That was a very grim view.

[AussieNeil Partner Administrator in reply to peacethruthestorm]

I'd like to know how many of those in the survey had been previously treated with older 'chemo' drugs like BR and FCR. I didn't see mention of this. We still need something beyond BTKi or BCL-2i treatments though.

Neil

[Lavinia-Blue in reply to AussieNeil]

Agreed on both.

I didn't see anything regarding comorbidity, Fish/Genetic factors, etc. either. (Though I do fall into the unmutated catagory.)

[Big_Dee in reply to Lavinia-Blue]

Hello Lavinia-Blue

I Concur, we need more testing, but where is the time? Those of us who are unmutated and have very aggressive CLL run on an endless belt to catch the next big treatment. I know that more than likely I will have to have some type of treatment every 2-3 years and each treatment relapse will come sooner. The thing I liked best about the B+R treatment is I did not relapse due to drug intolerance, but drug was no longer in my system. Since I tolerated B+R well, I can redo that treatment but with maybe diminishing results. Least of my worries is increased secondary cancers. My wife's cousin, who has been on ibrutinib for 9 years has also had bladder and prostate cancers. In spite of the doom and gloom we are lucky to have so many treatment options. Onward and forward with blessings.

[spi3 in reply to AussieNeil]

From what I can understand, as long as treatment is given they can survive:"

[SofiaDeo in reply to peacethruthestorm]

I am not reading it that way....since older statistics were worse. It's more a "let's not stop, 25% death is still too high". Remember, pre-2011 and these targeted agents, we all mostly died with these aggressive variants.

[Indolent]

This article left me a bit worried and confused. The very short median survival statistic following second treatment was eye opening. With so few details it is hard to assess what this means. Were these heavily treated patients with high risk features and multiple comorbidities? Or were they less impaired? Were the drugs administered sequentially or in parallel? ?????

I am hoping someone with a greater understanding of the details will be able to put more context into this study.

[SofiaDeo in reply to Indolent]

I am reading this as sequential treatments. Patients whose disease continues to progress in spite of treatment. Not that this was a group of people who got both drugs at the same time. *That* data is being collected/studies are being done on the combo therapies now.

The authors say, they don't know why the patients stopped. Some (about a quarter at 24%) were alive without any further treatment. Over 50% are on further treatment. So about a quarter being alive, with very aggressive disease, is disappointing but better than statistics from 20 years ago.

So this is actually *good* news, since this is a group of people starting 2011-2020. The past decade, when these newer agents first starting hitting the market. Before this decade, people died much faster. Nothing was around to work, if the standard chemotherapeutic agents didn't. IMO the authors are trying to get that approximately 25% who died, even better treatments so that mortality statistic decreases down even more. Their opening statement is "some see CLL/SLL as a solved problem". So I am interpreting this as "although these results are improved compared to previous generations, the death rate is still unacceptably high and we mustn't stop our search for new agents to get these numbers down even further". There is no talk of "previous generations" but based on my experience with cancer treatment providers, it's a given that the goal is to always, always, try to get the overall death rate down closer to "expected for the patient population age and other factors". With as close to a normal Quality of Life as possible.

[Catnap7]

Disappointing

[Lavinia-Blue]

For sure. 😞