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What Is the Goal of CLL Frontline Treatment?

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Published on February 6, 2019

At a recent town meeting in Atlanta, Patient Power host and advocate Jeff Folloder was joined by renowned chronic lymphocytic leukemia (CLL) expert Dr. Jonathon Cohen, from the Emory University School of Medicine, to discuss first- and second-line treatment options and explain the goals of frontline therapy. Watch now to find out more. 

This town meeting was produced in partnership with Winship Cancer Institute of Emory University and sponsored by AbbVie, Inc., Pharmacyclics, LLC and TG Therapeutics. 

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Transcript | What Is the Goal of CLL Frontline Treatment?

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.

Jeff Folloder:

Dr. Cohen, what are common first and second line treatment options, and what are your goals with these frontline treatment options? 

Dr. Cohen:                  

Okay. I’ll try to sum that up in a fairly brief statement.

Jeff Folloder:               

It’s a lot.

Dr. Cohen:                  

Yeah, you could spend, I think, an entire day just thinking about that. So, as Jean mentioned, at the very beginning when a patient is first diagnosed, the main question in my mind is does this patient have CLL? And assuming they do, does this patient need to be treated? And that’s really what I’m thinking about at the very beginning. But as we’ve just been discussing, in most cases patients are going to progress to the point where they need to be treated for a variety of reasons. And in that situation, there are a number of different things that I take into account, some of which are related to the disease and some of which are related to the patient.

So, as Jean pointed out, there are a number of different tests that we can do that can help identify those patients that are maybe going to do best with one particular approach to treatment, or, conversely, who may not respond as well to a particular type of therapy. We use the FISH test, and the mutation test to help us help make those decisions. But the third part of it which is equally important is the patient and their lifestyle and their preferences. So, I have some patients that—just to back up in my mind—there are two main approaches to treatment. There’s IV chemotherapy-based treatment, and then there’s oral therapy.

Now there are new studies and so forth where there may be some combinations, but in general, for most patients you are thinking about, are we going to do an IV chemotherapy approach or an oral treatment? And they both have, taking the CLL out of it, they both have their risks and benefits. So, the IV therapy, typically, is a little bit more aggressive, we administer it in the outpatient setting but it’s no uncommon for patients to end up being admitted to the hospital for infectious complications. It’s not uncommon for patients to require blood and platelet transfusions.

And many patients, depending on the type of IV therapy that we use may end up having to take a considerable time off work, or at least having to cancel some of their plans that they may have. We don’t always allow for patients for example go on exotic vacations if they’re in the middle of their chemotherapy. The benefit is that you are treated for six months, roughly, and then if you’re in remission then you’re done. And you may be done for six years or longer. And there is some data from MD Anderson that for patients that are in the lowest risk group, that some of our chemotherapy approaches, they have patients that they’ve been following for 10, 12, 15 years, and they’ve never relapsed. And that’s after getting a couple months of treatment.

Conversely, the oral therapies tend to be a little bit easier to take on a day-to-day basis. They tend to have much less of an impact on your daily activity, you can often continue with work, continue with travel, continue with whatever it is that you like to do. So, we heard, for example, my patient who’s still playing tennis actively while on an oral therapy; the downside is though, that at least right now in September of 2018 there is not necessarily a stop date for those treatments. And so, if somebody goes on an oral therapy they are, in a sense, committing to being on therapy indefinitely. Now I never like to say for the rest of your life because there are things that come up and there are reasons that people may stop, but there’s not necessarily a specific stopping point.

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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