Published on June 26, 2020
Clinical Trials Explore Use of BTK Inhibitors in COVID-19
Have chronic lymphocytic leukemia (CLL) experts found an equilibrium between protecting patients from the coronavirus and ensuring they receive the cancer care they need? Could BTK inhibitors offer protection from COVID-19? Are CLL patients more susceptible to other cancers?
In this segment from a recent CLL Answers Now program, host Andrew Schorr gets the answers from two experts, Dr. Alexey Danilov from City of Hope and Dr. Nitin Jain from the University of Texas MD Anderson Cancer Center. They are joined by long-term CLL survivor Nick Bohas. Tune in to learn more.
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Transcript | Clinical Trials Explore Use of BTK Inhibitors in COVID-19
So, it sounds like Dr. Danilov, you said initially, maybe with the beginning of the pandemic and you weren't so well equipped at the clinic level, you were working at your safety procedures and all that, there was a little bit of a move towards oral only therapy, right?
It sounds like now you and your peers are looking at the full range of options; protecting patient safety and looking at their situation, what's right for them. So, it sounds like we're getting a bit of an equilibrium, am I right, even with the pandemic?
Right. I'm not sure we have reached the equilibrium yet. And I think this is such a fluid situation. As you know, the number of cases in LA county is growing even though we were not hit so hard initially. So I don't know when the equilibrium will be reached. I think another point to mention is, how are these therapies that we are using in CLL actually impact COVID-19 itself? And I'm sure that you have seen in the news there is emerging information out there about clinical trials of BTK inhibitors in COVID-19. There were several publications about the potential activity of BTK inhibitors in COVID-19 situation, right? So I have to warn everyone on the call that this is very early data and outside of clinical trial, it's very difficult to know whether those treatments are effective. So there was a really nice publication from the National Institute of Health group where they administered the BTK inhibitor, acalabrutinib (Calquence), to 19 patients with COVID and in those 19 patients, they had good result and reduction in inflammation and improvement in health status. However, what we don't know is how those same 19 patients would have done without acalabrutinib.
So this is just a one arm study where there is not a comparator. In situations like this, when we are trying new treatment we always want a comparator group which does not receive treatment for a particular condition when the efficacy of the new treatment is completely unknown. Like, look what happened to hydroxychloroquine (Plaquenil), there was some hope initially and then turns out that it actually could be harmful. But there is data out there that potentially, BTK inhibitors may have some positive role. So that, I think, also is beginning to impact certain decisions. I think a lot of my colleagues are now saying that they would not stop BTK inhibitor in patients with CLL who is, for example, contracting COVID but also wouldn't necessarily start it on a patient with CLL who contracts COVID. But that's yet another factor which is beginning to weigh in into that decision. And I think we have to wait for another few months to know really what's the right thing to do. And then maybe we'll reach the equilibrium.
We'll have to have you back, we're going to talk. And we are going to have Dr. Mato on a program coming up on one of these every two week CLL programs because I know he's been gathering worldwide information as well.
Based on the backlog of CLL patients you have, has there been any graphics outlining the probability of these particular folks getting any other cancers either sooner or is there a high probability for certain types of treatments of CLL to get an additional new type of cancer or old type of cancer or whatever?
Which I did, I developed myelofibrosis. Dr. Jain, you want to take that one quickly?
Sure. Yeah, so I mean, patients with CLL irrespective of the therapy, they are known to develop other cancers at a higher rate than the general population without CLL. So some will be the skin cancers, some of the work from our group have also shown some of the solid tumors; lung cancer, I think, colon cancer. But the risk is slightly higher, it's not like the risk is 10 times higher. So I do recommend my patients to follow all the usual guidelines which is the general practice guidelines; to have a colonoscopy and the PSA and mammogram for a woman, those kind of things which any general medical doctor or primary care doctor would recommend. So, to stay up to date with that. And now specifically about treatment causing a cancer. So I think one of the things would be, we know with chemotherapies such as FCR, some with also bendamustine (Bendeka) – rituximab (Rituxan), they can cause some blood cancers such as what is called myelodysplasia, also sometimes it could evolve into AML, acute myeloid leukemia-
Myelofibrosis, for me, I did.
Yeah, so maybe myelofibrosis. So I think those are things which have been well recognized for patients who had prior FCR or for that matter, actually, we see it outside of CLL room as well, patients for solid tumor who get chemotherapy then they develop leukemias later and that also we treat in our department here. So that's a very specific association with chemotherapy and leukemia.
Thank you so much for being with us. I’m Andrew Schorr everyone, remember with Nick and Nitin and Alexey, we're all here for you. Remember, knowledge can be the best medicine of all.