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First- and Second-Line CLL Treatment Approaches

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Published on November 22, 2019

Key Takeaways

  • CLL patient subtype affects choice in therapy.
  • FCR and other newer agents for treatment.
  • Long term follow-up is ongoing for novel agents.

At a recent Town Meeting in Cincinnati, Ohio, Patient Power host and advocate Jeff Folloder sat down with noted expert Dr. Edward Faber from OHC (Oncology Hematology Care) to discuss treatment strategies for chronic lymphocytic leukemia (CLL), and ways doctors determine which is the most suitable while mitigating risks associated with therapy. Watch as Dr. Faber describes the use of novel agents, and how a person’s age and CLL subtype can influence the choice in first- and second- line treatment.

This program is sponsored by AbbVie, Inc, Genentech, Inc and Adaptive Biotechnologies. These organizations have no editorial control. It is produced by Patient Power in partnership with The Leukemia & Lymphoma Society (LLS), CLL Society and OHC (Oncology Hematology Care). Patient Power is solely responsible for program content.

Featuring

Because of this meeting, I created new networks by meeting new CLL patients, and we decided to keep in touch by emailing each other for support.

— CLL Patient, Town Meeting

Partners

The Leukemia & Lymphoma Society (LLS) OHC (Oncology Hematology Care)

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Transcript |

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.

Jeff Folloder:             

Dr. Faber, can you talk about potential treatment approaches for both frontline and secondary—topline of what the initial approaches look like?

Dr. Faber:                   

Sure. When I meet patients with CLL, to me the work starts even before you see yourselves in the office. Many folks have different ages, and there are different types of CLL, and how do we arrange this barrage of new medicines that are coming onto the landscape? It’s really to me the art of how we treat our patients. As you say, watch and wait…

Jeff Folloder:             

…watch and worry.

Dr. Faber:                   

I was going to get to that, and so we, I think as physicians have a watch-and-worry, too because our chemotherapy agents despite what we can read on the internet and oral agents are much easier, more convenient, and the side effect profiles are different and better in some respects. Our agents and the treatments of CLL can also harm folks, so I have a watch-and-worry too sometimes when I treat our patients with CLL. I would really try to avoid creating something that we can’t treat later on like an acute leukemia. For me, the standard—you mentioned FCR (fludarabine [Fludara], cyclophosphamide [Cytoxan] and rituximab [Rituxan]). and how that scared you—but there are obviously very smart people down at MD Anderson and FCR has been around for 15 to 20 years. Probably some of our largest and longest survival data is from FCR in that particular patient population.

Moving beyond that, because of side effects and availability we do have new agents; new versions of Rituximab, the ofatumumab (Arzerra) that you’ve mentioned, and we have obinutuzumab (Gazyva), and alemtuzumab (Lemtrada) and so forth and so on. Now, we have these pills that you’ve talked about that can be easy like ibrutinib (Imbruvica) as we move forward in clinical trials. There are new versions to try to avoid, atrial fibrillation and bleeding risks and hurting the liver, so from here there are very nice directions and algorithms in the literature. We try to take this heterogeneity of CLL and try to make some sense of it and then assign these treatments to folks.

Jeff Folloder:             

We have a fancy chart up on the screen that the folks are watching right now. It’s sort of a matrix. If you’re young and fit and IGVH mutated, FCR is a reasonable choice. Is that still state of the art?

Dr. Faber:                   

When we talk about survival, if that’s our endpoint, I believe it still is because it offers a decade or more of outcomes. We have all of these new agents as you pointed out there, but long-term follow-up is ongoing, so it takes time. In oncology a success can sometimes be a hindrance because the better we do the longer we have to wait to see how the newer agents might be better.

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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