Experiences with
Chlorambucil110 public posts
NICE Approves Acalabrutinib (Calquence) for specified groups of CLL patients in England
Patients for whom chlorambucil would've been an option at that time would have been the less fit patients who could not have tolerated FCR or BR.
Want to take advantage of all our features? Just log in!
or
NICE Recommends Acalabrutinib for treating CLL for certain groups
If FCR or BR is unsuitable, chlorambucil plus obinutuzumab is offered instead. Clinical trial evidence in this group shows that CLL takes longer to progress when treated with acalabrutinib compared with chlorambucil plus obinutuzumab. However, the overall survival benefit is uncertain.
SF3B1 Mutations
If and when these patients need treatment they should have a targeted therapy or look for a clinical trial of novel agents, rather than have chemo-immunotherapy such as FCR, BR or Chlorambucil.
https://ashpublications.org/blood/article/121/23/4627/31480/SF3B1-mutations-in-chronic-lymphocytic-leukemia
CLL/SLL Roundtable: Updates on Patient Management (including low dose radiation treatment for early stage SLL)
In that study, venetoclax plus obinutuzumab led to significant improvement in PFS and higher MRD negativity vs chlorambucil plus obinutuzumab.
Venetoclax plus obinutuzumab - the first chemotherapy-free, fixed-duration first line CLL treatment approved by Health Canada
plus one year of treatment with
VENCLEXTA had clinically meaningful and statistically significant
progression-free survival (PFS) and higher rates of undetectable minimal
residual disease compared to patients receiving a standard of care
chemoimmunotherapy regimen of obinutuzumab and chlorambucil
Leukaemia Care Webinar 8th April - a bit more information
That might be chlorambucil or, as AdrianUK mentioned yesterday, there is a patient access scheme for Acalabrutinib which is a good alternative for many patients.
Analysing and Resequencing Gene Panels from the UK CLL4 trial (1999-2004) is helping patients today.
The CLL4 study compared conventional chlorambucil therapy versus fludarabine - alone or in combination with cyclophosphamide - note there was no Rituximab in those days. End points were: survival, response to therapy, duration of response, toxicity and quality of life.
Adding Venetoclax to Obinutuzumab Prolongs Progression-Free Survival in Previously Untreated CLL
[i]Dated 1st September 2019[/i]
In a phase III trial of patients with previously untreated CLL and co-existing comorbidities, a fixed-duration regimen of obinutuzumab plus venetoclax reduced the risk of disease progression and death by 65%, compared with obinutuzumab plus chlorambucil.