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Making CLL Treatment Decisions

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Published on February 5, 2020

Key Takeaways

  • Approximately 80 percent of CLL patients are receiving targeted therapies.
  • There is a smaller subgroup of CLL patients where chemotherapy-based treatment may still be suitable.
  • Age, fitness, co-morbidities and genetics are all factors experts consider when helping patients make treatment decisions.

Leading experts Dr. Philip Thompson, from The University of Texas MD Anderson Cancer Center and Dr. Nicole Lamanna, from Columbia University Medical Center, discuss how treatment decision making has changed with the addition of new targeted options for chronic lymphocytic leukemia. Watch as the experts explain what factors to consider to find the most suitable therapy.

This program is sponsored by AbbVie Inc., Genentech, Inc. and Adaptive Biotechnologies. These organizations have no editorial control. It is produced by Patient Power and Patient Power is solely responsible for program content.


Transcript | Making CLL Treatment Decisions

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.

Carol Preston:                          

You mentioned to me, it was either last night or this morning, how complicated or complex, maybe that’s a better word, treatment has become because of the explosion of options in the last three or four years. So, can you talk about that a little bit?

Dr. Thompson:            

So, this is a good thing, it basically means that now we’re having so many more options that we can use; but it also means that you have to have someone that really understands the disease, making the decisions.

Because when you only have one treatment, anyone can give it. If your one treatment is chlorambucil (Leukeran) or bendamustine (Treanda) or rituximab (Rituxan), treatment decisions are simple, but—so now we have a lot of things that go into decisions about the first-line treatment. Now we have age and the fitness of the patient, and we have the genetics of the disease, and then we have whether the patient has other clinical problems, like, for example, do they have abnormal kidney function. And so, we put all of those things together, and we come up with treatment options. So, Dr. Awan was saying chemotherapy is dead, and that’s mostly true, I think. 

There is a small group of patients who are young and fit, and have what we call favorable genetic risk, and that group of patients is still doing very well with chemoimmunotherapy. But pretty much everybody else, which would be at least 80 percent of patients are getting these novel targeted treatments. And I think over the next few years we’re going to start to see results of clinical trials that are comparing combinations of these novel agents to chemoimmunotherapy, and I suspect eventually chemotherapy will be dead.

Carol Preston:                         

Dead and buried too, huh?

Dr. Thompson:            

It’s certainly on its way to being dead, but yeah. So, I guess the take-home message is most patients now the optimal treatment is going to be targeted therapies, the new oral targeted therapies is a smaller group of patients where chemotherapy-based treatment may still be appropriate.

Carol Preston:                      

So, I offer this to all of you, so how do you choose? Even after doing two tests, three tests, five tests, six tests—drill, drill, drill, get down to the essence of what the message that those cells are sending. With so many immunotherapy options now, a lot of them oral, I don’t even know if we’ll get into CAR-T cell, how do you decide, Dr. Lamanna?

Dr. Lamanna:              

Yeah, I think it’s exactly what Philip was saying. I mean before we didn’t have as much and so there was a lot less wiggle room, and it was more of an age and fitness, and co-morbidities like renal function and things like that would guide us in one way or another. Now, with all of that plus all these new novel therapies, we’re still looking at fitness and co-morbidities, but in addition, now, we can really factor in the genetics and the molecular mutations of the disease to self-select. So, that’s why that testing is important because we might steer people away from certain therapies; but we’re still then still talking about what inherently people are living with, what other co-morbidities.

Do they have heart disease? Are they on blood thinners? Things like that that might go hmm, now we have all these novel agents but these oral agents, it’s great they’re convenient, they’re pills, but they also have side effects too. So, when we talk about there are side effects to these new therapies as well; and so when we’re trying to then partition out or figure out what might be best for patients, in addition to the features of their disease, we’re still counting in what are their kidney function, do they have heart disease, what other medications are they on? There might be drug interactions. Are they able to access these new medications?

Not everybody gets approved for—the majority of folks do in the U.S., the international whole different beast whatsoever. A lot of them don’t have access to these novel agents even though they’re approved. So, there are financial concerns as well to take into consideration, so we look at all of these factors when we talk about, them, the right—and obviously with you all, try to talk about long, continuous therapy versus short-term therapy. These now have to be taken into consideration as we have all these new agents. Believe me, we’re very happy we have multiple choices, but we still, it is not one size fits all, we would all like to say that there’s a drug that cures everybody and we’re done.

If not, yet the case. And so, we really do need to factor fitness, co-morbidities, and disease factors. And the good news is, is now older folks can benefit from novel therapies that are just as well as our younger folks. So, really age shouldn’t be a factor anymore in treating the disease; but we do still take into consideration co-morbidities, renal function, organ function and things like that.

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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