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Optimizing Treatment Approaches: News From iwCLL

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Published on October 25, 2019

“We’ve come a long way from chemotherapy” says noted expert Dr. Farrukh Awan after returning from the four-day International Workshop on CLL (iwCLL) 2019 in Edinburgh, Scotland. What is the latest news in CLL treatment and research? Tune in to hear Dr. Awan discuss exciting advances made to improve chronic lymphocytic leukemia (CLL) care.

Click here www.iwcll2019.org to find out more about the conference. 

This program is sponsored by CLL Global Research Foundation. 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 |

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.

Carol Preston:            

Dr. Awan, you have recently returned from the big international workshop on CLL overseas. Jet lag aside, I’m just wondering what you took away from that meeting? Were you amazed by anything? Surprised by anything? What excited you from that meeting?

Dr. Awan:                  

I think the biggest and the most exciting thing is how this community of physicians and researchers from all over the world is coming together to deal with this disease and to figure it out more, to understand it better and eventually to cure it. And I think these are extremely hopeful times for us as physicians taking care of patients and researchers doing the research and primarily for patients because it’s all about them. And we are fighting this cancer together, and I think we’ve made some really dramatic advances in the last few years.

We’ve come a long way from chemotherapy. There have been so many advances with these new drugs that are easier to take, potentially even better than chemotherapy. So, I think for me, the highlights was that the combinations of these two drugs, or three drugs for that matter, for the treatment of CLL instead of chemotherapy, it seems to be the next standard of care in the near future. We still have to fine-tune the duration of therapy, what combination to use optimally. So, we did see some updated results from those studies that were already presented before, but we had got an update on both the ALLIANCE Trial and the ECOG studies.

Carol Preston:            

And for patients, what does that mean? And you’re talking about, what venetoclax (Venclexta) and ibrutinib (Imbruvica) combo? Or what combos are you discussing?

Dr. Awan:                  

Yeah, so I think the primary studies were combining ibrutinib and rituximab versus FCR for the younger patient population. And then on the older patient population above 65, it was ibrutinib versus ibrutinib combination with rituximab versus bendamustine (Treanda) and rituximab (Rituxan). So, I think those were the main combinations that were discussed. People are also trying other combinations of ibrutinib with venetoclax, which is also very promising. People are also trying to use a small run-in with chemotherapy and then doing these combinations, or together all of these things to improve their remission rate.

But I think it seems very clear that any of these combinations definitely appear to be superior than chemotherapy. Definitely in the younger patient population, and possibly also in the older patient population. And by that, I mean that definitely making patients live longer without cancer, but also overall patients are living longer potentially. It’s a little bit close to call on the older patient side, but on the younger patients it’s clear that patients who get these new drugs are beginning to live longer than they were with chemotherapy in the past.

Carol Preston:            

Let me ask you this because you did mention the C word. Not the cancer word, but the cure word. And, of course, every patient is hopeful that there will be a cure. On the flip side, cancer is a very wily beast and it has a way of finding all the nooks and crannies and being circuitous in where it pops up next and there are many patients, myself included, who have ended up with a second cancer. So how confident or how hopeful are you that there can be truly a cure where the cancer won’t morph into something else?

Dr. Awan:                  

Yeah, so those are very difficult questions to answer. So I think weanother major update from the meeting was this whole understanding of resistance mechanisms to these new drugs because the longer we’re using these drugs, the more we’re seeing resistance being developed in our patients. Primarily with ibrutinib, it’s well described now, that almost 80 percent of the patients tend to have a similar problem, but for the other 20 percent it could be a number of different things which we are not aware of. Similarly, for venetoclax, people have characterized a number of different mutations that can make the venetoclax ineffective.

So I think understanding resistance. And we also had presentations on these newer agents which can actually bypass those resistances. So we’re one step ahead and the cancer is evolving and so we are also evolving with the disease. So I think that’s very encouraging that we are one step ahead and the cancer then figures out something and then we figure out something else. So it’s a constant fight.

Carol Preston:            

What is your message of hope for patients?

Dr. Awan:                  

So I think the most excitingone of the most exciting things that is also happening in the field, is the cellular therapy, or CAR-T cells. And they have seen some very nice responses in patients who have really bad disease. The problem is when you talk about the cure word, what does a cure mean? I think that’s the key. Are you in remission for five years and then you call it a cure? Or are you in remission for ten? 15? 20? And we also know that patients can have disease comeback after nine or ten years. So the point of all of this is that you can’t really call any of this a cure this early.

So then what is the other surrogate endpoint that you can use? Okay, fine, I will have to wait 20 years to see if this actually gets cured, but maybe I can use an MRD assessment. That can help me predict which patient is expected to be cured. And I think those are the interesting challenges. I want to cure and I want to know if my treatment is curing you and I wanna know it now. I don’t wanna wait 20 years. I think that’s what we’re all passionate about and that’s where the whole focus is. We want to have good testing that establishes the depth of remission that is predictive of what is going to happen long-term.

So these are very big challenges, but I don’t think we’re that far away. I think our technology’s evolving vary rapidly, pharmacology is evolving, there’s a lot of pharma companies that are doing outstanding work, we have second-generation inhibitors, we have third generation inhibitors, we have inhibitors that overcome resistance. So it’s a fascinating time to be in our field. I think it’s a great time to be dealing with this cancer or if you’re a patient, because for the first time we have had options.

Carol Preston:            

So your research equivalent of a crystal ball, to which we say to all of our listening and watching audience, stay tuned. A lot more to come, Dr. Awan.

Dr. Awan:                  

Thank you so much for having me.

Carol Preston:            

Thank you so much for your time.

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.