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Second-Line Treatments in Development: Are There Backup Therapies If Mine Stops Working?

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Published on April 25, 2018

What options do chronic lymphocytic leukemia (CLL) patients have if the first-line treatment doesn’t work, stops working or causes severe side effects? Will treatments in the same class be effective? Dedicated CLL researcher Dr. Nicole Lamanna from Columbia University Medical Centergives updates on developing therapies, shares what factors your healthcare team considers when adjusting your treatment plan, and explains the benefits and risks of first-line and second-line therapy. Watch now to find out more.

 

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Transcript | Second-Line Treatments in Development: Are There Backup Therapies If Mine Stops Working?

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:

You know, the whole issue is if a medicine, no matter what condition it is, is not or no longer working for me is something in science being developed like a second line, second generation, third generation, and let's just use CLL as an example. 

So this oral therapy was developed, ibrutinib (Imbruvica), and also venetoclax (Venclexta), but let's talk about ibrutinib, a bruton tyrosine kinase inhibitor.  Well, now you're seeing a second-generation drug coming along, right?  So we're getting other ones, so if one doesn't work or no longer works you might have something to switch to.  Is that right? 

Dr. Lamanna:

Well, I think that data, we need to be a little cautious.  So I think…

Andrew Schorr:

…you don't know. 

Dr. Lamanna:

We don't know.  I think that there's a second generation of both the BTK inhibitors, so, as you said, bruton tyrosine kinase.  There's second generation of the PI3 kinase inhibitors, and so hopefully, and there's some head-to-head studies that will look at are these drugs—we presume that they're all equally efficacious, but are the side effect profiles better with the second generation? So that's one. 

And then the question that you're asking is, well, if somebody is on ibrutinib and then fails ibrutinib, do you switch to another BTK inhibitor, or do you switch to a different class all together?  And I think there's some retrospective data that we put together with other colleagues, Anthony Mato, a whole bunch of other institutions, that was retrospective, of course, but the signal was that if you're failing that class that you probably should—you might be want to be…

Right?  Because you may get a little bang, but we don't know if the other, second generations are necessarily better so much.  The response might be a little bit, but you probably won't last that long so you should probably go to a different class all together. 

Esther Schorr:

Isn't that a little bit like what happens with antibiotics if you're in—like if the first sulfa drug doesn't work you can always switch?

Dr. Lamanna:

Now, if you get a rash to an antibiotic, that's different.  So if you get a side effect to a drug like ibrutinib, can you switch to a second generation? 

Andrew Schorr:

It won't have the same side effect. 

Dr. Lamanna:

They may not have the same side effect profile, so that's good.  You have a rash to an antibiotic to switch to…

Andrew Schorr:

…less different in effectiveness. 

Dr. Lamanna:

That's different.  You got it.  So I think that's where that role is.  I think similar to chronic myelogenous leukemia or CML, where the second-generation TKIs became available.  If you were tolerating imatinib mesylate (Gleevec), great, you probably weren't switched at all to the second generation, but the newer folks who got diagnosed later on might have gotten started on a second generation.  So that's where that might come into play.

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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