Published on April 18, 2018
Some chronic lymphocytic leukemia (CLL) patients may reach a point on their treatment journey where therapy is stopped for an extended period of time. If treatment is necessary again, will CLL patients have the same initial response to previously used medicines? CLL expert Dr. Nicole Lamanna from Columbia University Medical Center, shares the latest clinical trial research on the efficacy of restarting a therapy and explains what the follow-up plan looks like. Watch now to learn more about CLL patient response to treatment over time.
Transcript | Stopping CLL Treatment: Will I Respond Well to the Same Therapy Again?
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So, Nicole, what I mentioned before you came is you're looking at combination strategies, you were just talking about, sometimes combined with infused therapies, rituximab (Rituxan) or ofatumumab (Arzerra) or obinutuzumab (Gazyva), and combining that with as you say novel agents like ibrutinib (Imbruvica) or venetoclax (Venclexta). You're also—there's more work going on about ibrutinib and venetoclax together.
Yep. That was also very exciting as well.
And can we get it where you could stop therapy at some point, whether forever or for an extended period of time.
One of the things that I mentioned, I just wanted to check with you, is when you stop if somebody—and then it shows up again is there a penalty for having stopped, or are those medicines going to work again?
Yeah. Obviously, this is an area where there's some data but a little more limited. That data really has to do with some of the venetoclax trials.
So there were—in one of the studies there were 13 patients who had ceased their venetoclax therapy, 11 of those who were MRD negative and actually still are in remission and off drug two years. And then there were two that were MRD positive and then progressed. So they were MRD positive when they stopped the venetoclax then waited until they actually progressed, so that gets a little bit to your question.
And then restarted venetoclax therapy and reresponded. Now, of course, these are really small and limited numbers, and hopefully we'll be able to look at that and see in some of these other studies with venetoclax, will patients be sensitive again to therapy and can you rechallenge them. And I guess all of us want to really—part of the issue we're really looking at is how durable is the MRD going to be, so if they're MRD negative for how long, and so we're hoping that we can capture, and again this will require a little effort, but looking at the—looking recurrent, evaluating for MRD even after people stop drug. It can't just be when they stop therapy. It really needs to be—we need to follow this.
You need to monitor it.
We do. We need to follow those patients because if we're going to ask this question or get the answer to this question, we really need to look at MRD long term. Whether that be every three months or every six months, that answer we don't have, but the only way we're going to know that is by doing these studies. So we have to look at MRD and then see how durable the MRD. Some of the studies are looking at not just stopping when you're MRD times one.
You know, maybe checking again and then stopping therapy, more than one sample. So stay tuned.