Progress

[Research123]

I've been on watch and wait for three and a half years now and it really pleases me the progress that keeps on coming. Here's another article:cancerhealth.com/article/th...

I think we all just need to buy as much time as we can can while you therapies arrive.

[Rohail]

Wouldn't this exhaust all your possible treatment options on one shot. I assume they are only doing time limited treatment but still don't you run the risk of using up Venetoclax and acalabrutinib both as options for a future treatment and in the event of a relapse? 35 months in remissionia great but it's not a long time.

[Research123 in reply to Rohail]

Not sure - are they one shot hits?

[AussieNeil Partner Administrator in reply to Research123]

Provided you don't develop resistance to any of acalabrutinib, venetoclax or obinutuzumab*, you should be able to repeat this triplet treatment or, for lower risk patients, a doublet treatment at least once. With the older chemoimmunotherapy treatments, whether to repeat a previous treatment was determined by how long your remission lasted, with I think a 3 to 5 year or longer remission time making it worthwhile.

Nowadays, it's becoming increasingly possible to actually test for resistance to venetoclax or a BTKi. It's easy to test for CD20 "resistance", with CD20 expression percentage, or at least bright or dim, reported in the immunophenotype flow cytometry test used for CLL diagnosis, though you'd need graduations of "dim".

Here's the link to my related answer to Rohail on this topic:

healthunlocked.com/cllsuppo...

*Addendum: The use of doublet or triplet therapy over a fixed period greatly guards against resistance developing. It's difficult for a resistant CLL subclone to develop when two or more drug classes are involved and for a limited time.

Neil

[LeoPa in reply to Rohail]

Not if i it cures you and that is the goal.

[BobbyFour]

And to add to the complexity, we now know that clones resistant to one treatment can actually disappear. It is sure nice to be in the time of deciding which option, versus not that long ago where there was so little.