Published on February 28, 2020
- Fixed duration therapy—which combines two or more drugs for a set timeframe—is an appealing alternative to ibrutinib, since it shortens treatment times and lowers costs for CLL patients.
- Two combinations showing promise in treating CLL are ibrutinib-venetoclax and venetoclax-obinutuzumab. The latter was approved by the FDA in May 2019.
- Ongoing clinical trials will help determine the best drug combinations for fixed duration therapy and CLL patient populations that will benefit most.
“This is a really exciting time for patients with CLL,” says Dr. Nicole Lamanna, as she goes on to explain that there are new drugs and new combinations of drugs showing promise in the treatment of chronic lymphocytic leukemia (CLL).
In this segment, Dr. Lamanna, a CLL expert from Columbia University Medical Center, speaks about the emergence of fixed duration therapy as a frontline alternative to ibrutinib (Imbruvica) for treating CLL. Watch now as she discusses the benefits and risks of fixed duration therapy, as well as what’s happening in clinical trials.
This program is sponsored by AbbVie Inc., Genentech, Inc. and Adaptive Biotechnologies. These organizations have no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.
Transcript | Fixed Duration Therapy for CLL
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I had FCR, went through six months, it wasn’t easy. Okay, but then I was done. I mean, I had some sinus infections and stuff that continued. And I needed antibiotics, it was a long tail related to that. My immune system kind of getting back but so, time-limited.
So, before now, with the oral pills, they’ve been saying, well, you’re going to have to take it. Just keep taking it. And they’re expensive. And then there’s been information with venetoclax (Venclexta), where with obinutuzumab-rituximab (Gazyva-Rituxan), could you have it for a fixed duration. But taking these two kinds of star drugs, putting them together, fixed duration where you could stop at some point. Maybe not forever, that’s a big deal.
Yeah, no, absolutely. I want to highlight and say again, this is a really exciting time for patients with CLL, because there are so many new drugs available and the combinations that everybody’s trying to tweak. I think all the combinations, whether it’s ibrutinib-venetoclax (Imbuvica-Venclexta), some of the other doublets, we’ll call them, doublets, or triplets, they’re all yielding very good responses, very high responses in front-line. I think the question that we all don’t know is do all people need dual therapy? Triplet therapy? Are there subgroups that might benefit from that? Is sequential therapy better? We have long-term data on how well patients have done on ibrutinib in frontline.
So, there are I think appropriate for clinical trial. I think that we’re still trying to translate into what will be in clinical practice, but we need the data to mature. I think there’s a very big appeal to do combination therapy, because of the time-limited duration, everybody wants to get off a drug.
And cost. And so that is an important thing. But with that, there’s extra toxicity that goes with any of these combinations. So, you may have to have a little bit of that. There’s always a little bit of a price to pay, because oral agents are not without side effects either. But if it’s in a time-limited fashion, that may push to move in that direction, absolutely. And then you have venetoclax-obinutuzumab and other combinations. So, I think they’re all gearing towards sort of limited therapy if possible.
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