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Should Novel Agents Always Be Used in the CLL Frontline Setting?

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Published on March 6, 2019

Patient Power community member Jeff writes in, “what are new combination therapies for patients with relapsed chronic lymphocytic leukemia (CLL)?” During this Ask the Expert segment, Dr. Richard Furman, from Weill Cornell Medicine, responds bygiving an update on CLL treatment, and explaining the course of care after relapse and the most effective use of novel agents. Watch now to find out more. 

This is a Patient Empowerment Network program produced by Patient Power. We thank AbbVie, Inc. and Pharmacyclics for their support.


Transcript | Should Novel Agents Always Be Used in the CLL Frontline Setting?

Now, what I'm really very excited about is the possibility of the combination of either BTK inhibitor therapy plus venetoclax or PI3 kinase inhibitor therapy with venetoclax.  

You know, both of these combinations really take advantage of the synergy that happens when you take a BCR antagonist like ibrutinib, acalabrutinib or idelalisib (Zydelig) and duvelisib (Copiktra) and combine it with a Bcl?2 inhibitor.  And it really sort of enables us to get very, very deep remissions with actually as short as just 12 months of treatment.  And so those are what we're currently testing in patients right now and what I hope will be the frontline treatment for patients in the not?too?distant future.  

But we are currently studying two different processes with relationship to the ibrutinib plus venetoclax combination.  So we're taking patients who become MRD negative on the combination after 12 months and randomizing them to either just get ibrutinib or to get placebo.  And so that's going to give us information as to whether or not it's safe to stop patients on the combination and treat them with nothing long term.  We'll see, one, how many patients relapse, and hopefully none, and, two, if they do relapse whether or not we can then restart ibrutinib and control their disease.  So this will provide us that important question as to whether or not we're giving up something by discontinuing the therapy. 

We'll have as our comparative those patients who got ibrutinib plus venetoclax for 12 months and then just remained on the ibrutinib. 

And so that will sort of be the patients who will continue on with their therapy, and then the other half will be patients who have discontinued all their therapy.  

My belief for going to venetoclax is that you're going to get almost all of the bang for your buck out of the first 12 to 24 months, so continuing it is unlikely to yield an additional benefit, so I think stopping it is safe.  But, once again, these are the studies that will provide us with those data.

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