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Finding the Right CLL Treatment Approach for Me

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Published on February 18, 2019

At a recent town meeting in Atlanta, Patient Power host and advocate Jeff Folloder was joined by a panel of experts, including Dr. Jonathon Cohen, from the Emory University School of Medicine, and Dr. Kerry Rogers, from The Ohio State University Medical Center, to give chronic lymphocytic leukemia (CLL) patients insight on the treatment decision-making process. The panel discusses the three major classes of CLL treatment and important lifestyle factors to consider when patients are weighing their options. Watch now to learn more.

This town meeting was produced in partnership with Winship Cancer Institute of Emory University and sponsored by AbbVie, Inc., Pharmacyclics, LLC and TG Therapeutics. 



Winship Cancer Institute

Transcript | Finding the Right CLL Treatment Approach for Me

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.

Jeff Folloder:

So, truly we are at the edge of personalized medicine. It’s not a one-size-fits-all, it’s not even a two bucket situation, it’s a we’re dialing it in to the exact person. Let’s take a look at the next slide then. We’re talking about MABs and MIBs and IBs, we’ve got chlorambucil (Leukeran), fludarabine (Fludara) and all that, we’ve got chemotherapy agents and immunotherapy agents, what is this giant soup that we’ve got to choose from, Kerry?

Dr. Rogers:                 

Yeah, so I think that when you look at standard therapies, I will point out from the previous slide that ibrutinib (Imbruvica) is approved by the US FDA as a first treatment for people. And also, we mentioned that FCR is not for everybody so there is some lifestyle choice in there too for people that just don’t want to do FCR even though they might benefit. So, combination therapy is a good approach to eliminate more of the leukemia cells and generally get deeper remissions. This is not the right approach for everybody because as you think about it, you don’t get anything for free, and the more things you throw in the soup the more side effects you’re gonna have.

So, what you’re getting is treatment for the CLL but what you’re giving up is side effects, that kind of thing. So, you’re never gonna get anything that has no side effects, so the more classes of drugs or types of drugs you throw in the more potential for side effects even though you might get deeper remission. So, it’s a balance of those when you’re thinking about treatment for any individual. So, the class of agents on the screen there, is actually the oldest or first class of agents we had for CLL, including the oral alkaloiding agent chlorambucil which is very tolerable but, in many cases, not as effective as these other agents. It’s a pure nucleoside analog therapy, bendamustine (Treanda), which has some properties of both, and then another IV chemotherapy agent called cyclophosphamide(Cytoxan) and all these drugs work by interfering with growing and dividing leukemia cells to kill them off.

I don’t know exactly how to describe it but they kind of work by killing more rapidly dividing cells and they kill the leukemia cells better than they kill healthy cells in the body. But they’re still cell killing agents compared to immune therapies which help your immune system kill the cells, or oral targeted agents where instead of just killing cells they actually are specifically getting into the leukemia cells, binding to something in them and altering their cellular physiology in a way that makes the leukemia cells die.

Jeff Folloder:               

We’ve got three major classes of treatment option. We have traditional chemo, we have monoclonal antibodies, and we have these small molecule inhibitors, and sometimes we pick and choose from the menu. We take some from column A, some from column B, and some from column C. and just to summarize, this is under the heading of personalized medicine because of all of those tests that you’re running we’re learning whether the patient is mutated, or unmutated, if they have a particular chromosomal abnormality that might be a little bit more serious than someone who’s just perking along at a low level of indolence, as it were. But you get to pull some of everything and customize it for most patients, is that fair?

Dr. Cohen:                  

That’s exactly right. And that’s where we talk about personalized medicine as far as the patient’s own disease but it’s also personalized medicine in that we personalize it to the patient, and their life, and what works for them. So, I take care of some patients so I’m at Clifton Road here in Atlanta, but they may live 150 miles away, and they may or may not have somebody to drive them to campus. And so, for them trying to go on a combination IV chemotherapy where they have to be here three days in a row every month is just not feasible. And so, for that patient, regardless of what their disease biology is, we may think about an oral therapy that they can take at home.

On the corollary we have some patients that are already on 15 pills at home, and the thought of adding an extra pill that they have to take every day is just not something that they necessarily want to do, and for them they like the security of knowing they come in, they get their treatment here with us, and then when they leave they know they’ve gotten their therapy. So, you really have to take into account the patient and their wishes their support system, other medical conditions that they may have that may interfere with their ability to tolerate therapy.

And so, it really is, there’s the disease component, but then there really is the patient, and it’s something that we truly think—I think a lot about anytime I’m starting a patient on treatment. And I have a pretty extensive discussion with them about the pros and cons and why one approach might be better for them.

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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