Considering FCR? What You Should Know Before Starting Chemotherapy

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Andrew Schorr:

It was brought up by Wayne Wills, who is a veteran patient.  He's been on ibrutinib (Imbruvica) for a long time and doing well, but he brought up what younger patients worry about related to FCR, which I had years ago, and, as you know, whether it's from that or other reasons, I eventually developed this second cancer, myelofibrosis, and some of the docs certainly in the U.S. where they have more options maybe than what had been available in Canada or some other places have said, well, we're trying to avoid any regimen with chemo for fear that a second cancer could develop the down the line.  

What's your take about that, because I know even now there are trials with venetoclax (Venclexta) and rituximab (Rituxan) or others and having no chemo?  

Dr. Lamanna:

Yeah.  So, well, first I think there's no doubt that obviously we—I think there are still certain potential patients where FCR might relevant for, but, yes, obviously, ibrutinib is available for those patients too.  And so I think that you have to sit down and go through this with the individual patients because there may be a small cohort that that might be something that's still—that person may still benefit from knowing the potential late-term toxicities.  And so you have to have that open discussion.  

So I think anybody who you're considering—and, again, it's a small cohort—if you're considering FCR that group could also get ibrutinib.  So certainly until that data is available, and that will—there is frontline data that will be coming forth where, where what is the best therapy to get as your initial first-line treatment.  There's randomized trials that hopefully will give get the answer to that.  

When you talk about combinations there's no doubt.  So there are many folks that may be moving away in general from chemo immunotherapy, traditional chemo immunotherapy because of those reasons about late-term toxicities and so on and so forth.  And so there are lots of trials that were looking to see whether or not those combinations, A, will be as fruitful and beneficial where the long-term therapies—or I should say the long?term gain, either the response duration is very long or the overall survival is improved.  

I think we just need more data, but yes, there has definitely been a move in the clinical trial arena to sort of combine novel agents with antibodies or even just novel agents with novel agent to move away from chemo immunotherapy.  But there's lots of unanswered questions with that, too.  You know, how long do you continue the oral agents, the MRD-negative area that you brought up before, are we going to have people indefinitely on these pills for the rest of their lives?  What's the long-term toxicity 20 years of those agents, or can we abbreviate the oral agents?  

There are a lot of unanswered questions, but at least that frontline of what do you get as my first therapy, FCR versus let's say ibrutinib, at least it's a novel agent, that data at least that trial has been run, and we can see what that data shows. 

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.