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Advances in Treating CLL-Related Fatigue

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Published on December 15, 2015

Dr. Zeev Estrov, from the University of Texas MD Anderson Cancer Center, discusses the fatigue in CLL patients stating, “Controlling inflammation in a smart way will prolong people’s lives and significantly increase quality of life.”  Listen as Dr. Estrov examines the ongoing JAK2 inhibitor research and its positive effect on symptoms.

Sponsored by CLL Global Research Foundation.

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Transcript | Advances in Treating CLL-Related Fatigue

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.

Andrew Schorr:    

Welcome to Patient Power. I’m Andrew Schorr. We’re with Dr. Zeev Estrov who is a CLL specialist at MD Anderson. Welcome, doctor.

Dr. Estrov:            

Thank you. 

Andrew Schorr:                  

Dr. Estrov, one of the common side effects of the illness of CLL is fatigue.

Some people are just so tired. And you’ve been studying that. What are we learning now?

Dr. Estrov:            

So the fatigue is induced from overproduction of cytokines that is commonly found in patients with CLL.  And many patients, although they don’t need treatment for CLL, the quality of life is terrible.

And we studied, thanks to grants that we received from the CLL Global Research Foundation, the pathogenesis of CLL.  And what we found was that when you stimulate the one of the things that [is] happening is the JAK2 gets formulated and activated then regulates the same signal, which leads to overproduction of inflammatory cytokines. 

So it took me a year or two years to convince Insight to allow me to perform a clinical trial of ruxolitinib (Jakafi), which is a JAK2 inhibitor in patients with CLL.  

Andrew Schorr:                  

And the idea was if you inhibit the JAK2, you could deal with the inflammation and the fatigue?

Dr. Estrov:            

Correct.  So we have already enrolled more than 50 patients overall.

Most patients benefit—some of them fantastically to this treatment. And in 20 patients with measured cytokine levels and cytokine levels are dramatically reduced, and the reduction in cytokine levels correlates with the degree of clinical improvement, which supports our hypothesis.

Andrew Schorr:                  

Now, just so our viewers understand, let’s say when you have the flu, flu-like symptoms, and you’re just so tired, that’s cytokines at work, isn’t it? 

Dr. Estrov:            

Absolutely.

Andrew Schorr:                  

So it’s that kind of cytokine production where there’s inflammation going on.  And so the JAK2 inhibitor can tamp that down. 

Dr. Estrov:            

Correct.  But the body needs cytokines when you are sick. That’s why it produces it. So shutting it down in other diseases like the flu, for example, might be a mistake. So we have to be very careful and figure out what we are doing, if we are not overdoing.

Andrew Schorr:                  

So the idea is, with a common side effect and, as you said, some people who yet haven’t even had CLL treatment, would you have a medication that might be effective in helping them live a higher quality of life?

Dr. Estrov:            

Well, we are developing it. So we are looking at other medications and other options.  And in a broader sense, inflammation drives many diseases, not only cancer like arthrosclerosis or diabetes.  And controlling inflammation in a smart way will prolong people’s lives and significantly increase quality of life. So this is something that we are going to see in the upcoming years.

Andrew Schorr:                  

Now, this is an important question I should just mention to our viewers. Dr. Estrov is doing this as part of the CLL Global Foundation. And that’s trying to advance the understanding of these scientific questions to come up with approaches, really issues that many of us are living with.

So I’m very excited about it, Dr. Estrov.  So when you look at this, and you’re, of course, a specialist, and put it all together in CLL.  We had the big iwCLL meeting.  Colleagues were discussing all of these issues.  Are you encouraged for people, not just with fatigue, but generally where we can treat CLL better and have a higher quality of life? 

Dr. Estrov:            

So what is interesting from this study is that not only there was improvement in symptoms.  There was an indication that there was improvement in the CLL burden. 

Andrew Schorr:                  

Wow. 

Dr. Estrov:            

So what we are trying to do is convince Insight to allow us to study ruxolitinib as a therapeutic modality in patients with CLL. 

And it’s not enough to treat the disease and see remission. It’s important that the patients have good quality of life.

Andrew Schorr:                  

Well, a lot of questions still to be answered. But it sounds like you’re a detective on the trail.  So thank you, Dr. Estrov, for all you’re doing in this research. And we’ll be interested to hear and report on what you find out. Thanks for your work, sir.

Dr. Estrov:            

You’re welcome. 

Andrew Schorr:                  

Okay.

Andrew Schorr with Dr. Zeev Estrov from MD Anderson as we tackle one of the tough issues in CLL for so many people, and that is fatigue.  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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