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Making Treatment Decisions: How Does Mutational Status Help Classify CLL Patients?

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Published on February 18, 2019

How do doctors determine whether a novel agent or standard therapy is more suitable for a chronic lymphocytic leukemia (CLL) patient?  On-site in San Diego at the 2018 American Society of Hematology (ASH) annual meeting, CLL expert Dr. Javier Pinilla-Ibarz, from the H. Lee Moffitt Cancer Center & Research Institute, joined Patient Power to discuss what factors help classify patients into subsets and map out the course of treatment. 

Sponsored by Pharmacyclics.

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Transcript | Making Treatment Decisions: How Does Mutational Status Help Classify CLL Patients?

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.

Andrew Schorr:

So, Dr. Pinilla, where we are is we’ve been hearing about two novel agents used together. But maybe to a two-year stopping point.

Dr. Pinilla:                   

Sure. Less amount of time, a year of 15 months in the frontline studies.

Andrew Schorr:          

Right.

Could we do that? Or is there still a place for chemo that can have some side effects as well? Sometimes, the risk of a second cancer, right? 

Dr. O’Brien:                

Yes.

Andrew Schorr:          

It remains a concern. So, is that where you think we’re going to end up with do we have some fixed time of novel agents versus some advantage of still using some chemo for some people? How do you think it’s going to shake out? 

Dr. Pinilla:                   

So, I think it’s all about stratification of our patients. Age is very important. Obviously, the IGHV status is extremely important as the mutation status of heavy chain of immunoglobulin is extremely important because, as Susan was mentioning, these patients are doing extremely well. With Nitin, his study knows the institution, and he can really discuss even further, is how to increase even further these good data that we have had with FCR trying to decrease the toxicity of FCRs doing less chemotherapy, adding another agent, as Ibrutinib or even a second generation antibody with a goal to do limited therapy.

But substantially increase the number of complete responses, even MRD, who are the ones who have been associated with these long term remissions, with these chemo immunotherapy regimens. And I think it’s something that I really, really feel like we’re going to continue to study to really increase. So, at the end of the day, we cannot say that chemo-immunotherapy is completely gone. Obviously, in my practice, my patients because you mentioned finance and toxicity may ask for limited duration, even at the frontline. So, we need to really discuss this with our patients. And different patients may have different points of view about getting long-term therapy versus fixed therapy.

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.