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What Options Are Available for Relapsed CLL?

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Published on July 16, 2019

Chronic lymphocytic leukemia (CLL) expert Dr. Nitin Jain, from The University of Texas MD Anderson Cancer Center, explains what factors to consider when evaluating retreatment options. What options are approved for relapsed patients? How does a person’s genetic subtype influence retreatment? Tune in to learn more about the course of care for relapsed CLL.

This program is sponsored by Pharmacyclics. This organization has no editorial control. It is produced solely by Patient Power.

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Transcript | What Options Are Available for Relapsed CLL?

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:

You’ve alluded to the changing landscape, as I refer to it, with approved therapies, and then, if you add promising experimental therapies in a university setting like you do, you have a wide range of choices to discuss with somebody related to if and when remission ends, what can we offer you? So, how do you decide with the patient? Is it this? Is it that? Is it that over there? What are you looking at to make those recommendations?

Dr. Jain:                     

So, I think in large part, again, if you’re talking about relapsed CLL—so, patients who have had prior therapy and then their disease has come back – I think in large part, that would depend on what your prior therapy was for that particular patient, and also, what the genetic subtype is. For example, we heard about deletion 17p. These days, I think if you are deletion 17p, really, the general thing would be to stay away from chemoimmunotherapy.

So, let’s suppose you had FCR in the past, you have 17p deletion, now the disease comes back after three years or so, which we would expect after FCR if you have deletion 17p, because it generally comes back quickly. I think in that situation, then you’ll start looking at—and, what I discuss with my patients is that right now, ibrutinib is available for our patients, venetoclax (Venclexta) in combination with rituximab is available, and those are the top two regimens to choose for. 

There are other approved drugs for patients with CLL. There is a drug called idelalisib (Zydelig), which was approved several years ago. There’s a drug called duvelisib (Copiktra), which was approved more recently. But, I think in general practice and in our practice, we rely on either ibrutinib or venetoclax as your first targeted therapy option after you have failed chemotherapy.

So, those are options we discuss—ibrutinib (Imbruvica) versus venetoclax, the risk profile. One is a lifelong therapy; the other is a time-limited therapy because venetoclax is generally given for one to two years. So, those are the things we discuss with the patient, and at the end of the day, it’s a mutual decision between myself, the treating physician, and the patient what they want to choose for. So, those are the things we think about deciding on the 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.