Goals of Re-Treatment for CLL

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Topics include: Living With Chronic Lymphocytic Leukemia

What are the goals of therapy for relapsed chronic lymphocytic leukemia (CLL)? What dialogue should CLL patientshave with their healthcare team about re-treatment options?  During this segment from our “Relapses in CLL: Allaying Fears & Taking Action” program, expert Dr. Nitin Jain, from The University of Texas MD Anderson Cancer Center, explains how to take an individualized approach to setting re-treatment goals.

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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:        

So, Dr. Jain, talk to us about the dialogue you have related to goals of retreatment with a patient. Some are infused therapies, some are oral therapies, sometimes oral only, does somebody wanna travel, is somebody retired and close to home, just gardening locally? What kind of conversations do you have with people as you look at this array of things that you could offer?

Dr. Jain:                     

A good thing, in a way, is that all the oral therapies or new therapies are kind of a class apart in chemotherapy. In the sense that these are oral therapies, much easier in most senses than chemotherapy, and we are talking some long-term remissions for patients. Whether you’re talking about ibrutinib or venetoclax (Venclexta), the goal is long-term remission. Now, you can further start teasing out what kind of remission you’re talking about. Are you talking about complete remission? Are you talking about MRD-negative remission?

In general, for me, from the patient’s perspective, all these new therapies are quite effective for a majority of the patients. Eighty to 90 percent of the patients will achieve remission which will last several years. So, for me, I think talking to the patient comes down to – as, Andrew, you were pointing out—with venetoclax, it’s a pill, but there is this tumor lysis monitoring we have to do early on, and at MD Anderson, we see many patients who travel from far-off places, so, many times, it’s a bit logistically challenging for them to be here once a week for five weeks because we have to start venetoclax.

And, ibrutinib in that aspect could be a bit easier. Certainly, if you have to have venetoclax, you also have to use rituximab (Rituxan) or obinutuzumab (Gazyva). Again, there’s an IV complement to it. So, we certainly discuss, as I said, these logistics aspects with the patients. Obviously, asking the goals of the patient. I would say most of the patients certainly want to achieve remission, want to achieve control of the disease. I would say if they try this, and if you were to say there was a light ongoing continuous daily therapy versus maybe one or two years of venetoclax—I think that’s what the recommended duration is.

I think many patients may choose time-limited therapy just because they feel that they are done rather than just keeping something forever and ever. But, overall, I think both these therapies – and, as I mentioned, idelalisib (Zydelig) and duvelisib (Copiktra) are other approved therapies—all the four therapies are overall effective in relapsed CLL for the majority of the patients. So, that’s a much more positive development than what we had before this era.

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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Page last updated on July 18, 2019