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Is Chemotherapy Still Used in CLL?

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Published on January 24, 2020

Key Takeaways

  • For the majority of CLL patients, chemotherapy is not a viable treatment option.
  • Patients who qualify for chemotherapy may choose it over novel targeted therapies, despite known side effects, because data shows a high likelihood of long-term remission. 
  • Long-term remission data does not yet exist for newer targeted therapies like ibrutinib (Imbruvica) and acalabrutinib (Calquence), but early results look promising.

“It is true, for the majority of patients, chemotherapy is not an option,” says Dr. Nitin Jain about whether chemo should still be used for treating chronic lymphocytic leukemia (CLL)Dr. Jain, from The University of Texas MD Anderson Cancer Center, joined Patient Power at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition, to share CLL research updates and to discuss current treatment options. In this interview, Dr. Jain explains which patients qualify for chemotherapy and why, despite known side effects, they may still choose this option over newer targeted therapies. Watch now to learn more.

This program is sponsored by Pharmacyclics and Janssen Biotech. This organization has no editorial control. It is produced by Patient Power, and Patient Power is solely responsible for program content.

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Transcript | Is Chemotherapy Still Used in CLL?

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.

Michele Nadeem‑Baker:

Well, this brings me to the question that I've been hearing talked about next.  Is chemotherapy about to be gone in treating CLL?  

Dr. Jain:

So I think that's a fair—it's a debate we have in medical meetings these days.  You know, one person speaks that—that once CLL investigator says, oh, chemotherapy is dead, other one says, oh, maybe there is some role for chemotherapy.  

I think it is true that for the majority of the patients the chemotherapy is not a viable option.  So if you look at the group of patients I said where chemotherapy may have a role, young patient, physically fit patient, does not have the deletion 17p, does not have TP53 mutation, also has IgVH mutation, that constitutes maybe 8 to 10 percent of all CLL patients.  So for 90 percent of the patients we all leave the chemotherapies out. 

Now the debate rests with these 8 to 10 percent of patients where some of the data obviously from MD Anderson Group, some other groups as well about long‑term benefit from FCR has to be countered with the data that FCR can lead to some secondary malignancies, especially MDS and AML, which is certainly not—which is a tough thing.  

So I think these are the individual discussions with the patients.  So I tell my patients who meet the profile that they get chemotherapy, that they can get chemotherapy, I present the option that the chemotherapy is time-limited, there is a risk of infectious complications, and there is a risk for this MDS, AML, but there's a possibility that you may be remission free 10‑plus years down the line, versus the possibility of using these novel targeted therapies, ibrutinib (Imbruvica), acalabrutinib (Calquence), venetoclax (Venclexta), where certainly we don't know 10‑plus years data but all the data looks pretty promising. 

And I let the patients decide what they want to do in terms of the treatment options, because I think—for that group of patients I think you could argue both ways, so I present the data, and then the patients can decide. 

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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