Hypothetical Question About Various Treatments

[DRM18]

Hi everyone,

Just wondering here, trying to chart out various future scenarios. (You know how it goes.)

Say someone's treated with Venetoclax and Obinutuzimab, the classic one-year treatment, then they're off all CLL meds for a couple years.

Now, say they need re-treatment (after a couple years).

I know that V+O is repeatable, and I also know the longer the time between V+O treatments, the better.

So: imagine, for a second-line treatment, the patient/doctor chose not V+O, but Acalabrutunib.

Were the patient to be one that drug (A) for several years, and if that drug were to eventually stop working, could the patient then go (way) back to V+O for a third treatment?

At this point, like, maybe 10 years might have passed since V+O was first used.

I ask because I only ever hear of V+O being repeated sequentially, not with another med--maybe many years' worth of said med--in between the V+O.

Have at it!

... Oh, and yeah, I realize no one really knows. Just wondering what ya'll think.

--Dave!

[AussieNeil Administrator]

Keep in mind that the underlying concern is reducing your risk of developing resistance, while minimising your risk of adverse events from your treatment drug(s) and any support drugs recommended. Currently the BTKi drugs come out on top here in keeping CLL under control for 5 to 15 years or so. The upper limit is still being determined.

I can't see any reason why switching to a BTKi then later back to V+O is out of the question. Eventually we'll know which markers predict the best survival odds for the different treatment paths.

Neil

[DRM18 in reply to AussieNeil]

'twas my suspicion, and my hope, my friend.

You've taught me well over the years!

--Dave!

[Sushibruno in reply to DRM18]

good answer to Neil🙂.

[Sushibruno in reply to AussieNeil]

Neil 5, 15 years? "the upper limit is still being determined?

[AussieNeil Administrator in reply to Sushibruno]

Yes that's correct. This year some of the early recruits to the first trial of ibrutinib, back when it was known as PCI-32765, entered their 11th year of maintenance treatment on the first of now 15 BTK inhibitor drugs for CLL. If ibrutinib stops working for them, they can switch to one of the non-covalent bonding later generation BTKis and who knows how long they'll be able to keep their CLL under control?

Neil

[Sushibruno in reply to AussieNeil]

🙂🙂thank you Neil. I hope you're well.

[CTSteve]

the CLL Society is having a webinar about treatment strategies next Wednesday. cllsociety.org/playing-cll-...