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Combining New and Emerging CLL Treatments

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Published on January 18, 2016

Dr. Michael Keating of MD Anderson Cancer Center joins us for another segment in our Ask The Expert series, answering a question about the potential combination of the novel agent ABT-199 (Venetoclax) and the approved treatment obinutuzamab (Gazyva) and whether this is a treatment approach that could be effective and safe.  Dr. Keating breaks down the two therapies, explaining their target and dosing.

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Transcript | Combining New and Emerging CLL Treatments

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.

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:

 So people are asking about the combination ABT-199, what is being now called Venetoclax, with obinutuzimab (Gazyva) and whether it is a treatment regime that could be effective and what the side effects would be going along with that.

Dr. Keating:         

They’re very different drugs.  One will inhibit a survival protein called Bcl-2 that keeps the CLL cells alive for a long time, and it is probably the most potent agent that we have in getting rid of disease from the marrow.  And the counts go down very, very, very quickly so that just a tiny dose is often given in hospital under observation to make sure the cells are not developing at a dangerously rapid rate.  But commonly those patients would have a white count of 100,000, and then the next morning they will have a white count of about 50,000.  And then you go onto slowly increasing doses on a daily basis, and there’s less long-term follow-up with this than they have been with ibrutinib (Imbruvica). 

And then obinutuzumab is a new antibody that interferes with CD20 as a target, and it’s been demonstrated to be more effective in CLL when combined with chlorambucil (Leukeran) and then a rituximab, so that it’s now an agent of choice so that you can use chlorambucil and obinutuzumab up front. And you have to stagger the first couple of doses on day one, day two, because you get a number of theorentials more consistently than in rituximab, and usually it’s given once a week for four doses or thereabouts.  And then once a month for a period of time, and we do know that ABT can be very safely combined with rituximab (Rituxan).   

So the question is can it be combined safely and effectively with obinutuzumab, and those studies are still in the fairly early days.  

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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