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Risk of Secondary Cancers When You Have CLL

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Published on September 4, 2020

What's the Latest Research on CAR T-Cell Therapy and Secondary Cancer Risk for People With CLL?

CLL expert Dr. Richard Furman from Weill Cornell Medicine discusses when he looks at CAR T-cell therapy as a treatment option and how it compares to BTK inhibitors. Host Andrew Schorr who is living with CLL and later developed a second cancer, myelofibrosis, also asks if having CLL makes someone higher risk of a secondary cancer diagnosis and what precautions and monitoring should be done. Watch to hear the full discussion.

This is Part 4 of a 4-part series on CLL. Watch all segments in the series below:

This program is sponsored by AbbVie, Inc., Genentech, Inc. and Adaptive Biotechnologies. These organizations have no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.

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Transcript | Risk of Secondary Cancers When You Have CLL

What are the Drawbacks of CAR T-cell Therapy for CLL Patients?

Andrew Schorr: 

Let's go on and talk a little bit about research. So we're still hearing about studies of chimeric antigen receptor T-cell therapy. And some really sick CLL patients I’ve met who've gone through therapies over many years and then they stopped working, went on to trials and CAR T. What do you think is going to happen there? Because that's a pretty aggressive therapy and very expensive as well. 

Dr. Furman: 

Well, it's interesting, from a cost perspective, CAR T-cell therapy is not much more expensive than actually any of the BTK inhibitors, the difference is whether or not it's annualized over a couple of years of whether or not it's paid all at once. I, as a physician, really believe that we have to offer the patients the best things that we can. And I actually do prefer BTK inhibitors because they are, I think, more efficacious and far safer than CAR T-cell therapy. One area where I think CAR T-cell therapy may still play a role in CLL, are in those people who are in transformation. So the people who are developing Richter’s, which really don't respond to BTK inhibitors but still could respond to CAR T-cells there. On outside of that, I really do restrict where I recommend CAR T-cells.  

Secondary Cancer Precautions for CLL Patients

Andrew Schorr: 

Okay, let me back up for a minute, Dr. Furman. So here we are, we're doing this during summertime, I think CLL patients know that they have to be careful with the sun, we worry about skin cancers, I developed a different kind of second cancer, myelofibrosis, as I mentioned, what is our risk of other cancers and what do you tell patients as far as precautions or monitoring? 

Dr. Furman:

So I do really recommend, CLL causes symptoms by three ways. One is the CLL cells taking up space. The second is the immunodeficiency and the third is actually an increase in autoimmunity really directed against blood targets. So an autoimmune hemolytic anemia and ITP. The immunodeficiency probably translates into a loss of anti-tumor immune surveillance. And so we do see an increased risk of secondary cancers. Now the vast majority of those are going to be skin cancers just because you see skin cancer so commonly, especially because 25, 30 years ago, we were all using suntan oil and baking in the sun. And I have had CLL patients who have had 30, 40 basal cell and squamous cell carcinomas resected over the course of years. So, no skin cancers are exceedingly common. And I do recommend that every CLL patient be screened at least once a year by a dermatologist. And if they do have skin cancer, is actually going to show it's either six or three months depending upon how frequent and the time. Now importantly, these tend not to metastasize, but of course the earlier they remove the smaller the scar. 

Andrew Schorr: 

All right. So what about other cancers, though, non-skin cancers? 

Dr. Furman: 

So we really don't have data of doing anything differently from the other non-skin cancers. I'm very aggressive with making sure everyone is up to date with their routine health maintenance. And so that includes mammography for women and colonoscopies for everyone and prostate checks for men.  

Andrew Schorr: 

So just to sum up, it sounds like you have a range of treatments now, and sophisticated monitoring for all patients now, so that they with the proper knowledgeable CLL specialist can get what's right for them.  

Dr. Furman: 

Absolutely. And I think the outlook for CLL patients is incredibly good right now, the vast majority, and everyone else who don't currently have an excellent outlook, some of what we're now doing can really make the difference so that we could very much in the near future say that everyone should expect to have an excellent outcome.  

Andrew Schorr: 

Thank you so much for joining us. I'm Andrew Schorr. Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.


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