transfer from Ibrutinib over to V/R

[Stacky66]

What’s the normal procedure in uk for transferring over from Ibrutinib to V/R,my Ibrutinib was stopped 4 weeks before new treatment started resulting in massive lymph node flare up and still growing 🥲

[alpek]

I believe most specialists recommend overlapping the Ibruitnib with Venetoclax during the ramp up stage of Venetoclax which lasts 5 weeks, this is to avoid a flare which it sounds like you are experiencing.

[Skyshark]

I don't think there is a NHS procedure, it's not in protocols. They actually say stop on progression.

clatterbridgecc.nhs.uk/appl...

To continue until progression or unacceptable toxicity.

But there is this :-

British Society of Haematology guideline, 21 March 2022.

onlinelibrary.wiley.com/doi...

In section titled MANAGEMENT OF RELAPSED OR REFRACTORY (R/R) CHRONIC LYMPHOCYTIC LEUKAEMIA, Below "BOX 1"

"If a patient is relapsing on a targeted agent, treatment should be continued for as long as the patient derives clinical benefit until the subsequent targeted therapy is available, as there is a risk of rapid progression once therapy is discontinued."

If they can't give a satisfactory answer why they didn't follow that guideline you may want to think about a visit to PALS.

After the initial low dose and first full dose of Rix there is a possibility of being offered a rapid rate 90 minute infusion at cycle 3. If they use this they should inform the patient that it is "off label" and get consent, page 4 of this guide below.

clatterbridgecc.nhs.uk/appl...

unlicensed, inform patients in line with the unlicensed medicines policy

nssg.oxford-haematology.org...

The chemo nurses may have found other ways to introduce it. (Obin they turned up at my chemo chair with a fan of rate sheets saying "We don't know which one to give you!" I helped them out by selecting the off label one.) I think recording of "verbal consent" is a bit slap dash and they should get the patient to make their mark on each rate sheet, which goes in the file.