[ Englisch] Could Inhibitors Be Used in the Frontline Setting?

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Topics include: Treatments

Could newer inhibitor treatments be used in the frontline setting? Dr. Nitin Jain of the University of Texas MD Anderson Cancer Center takes us through the factors to consider--such as age and stage of disease--when deciding on an initial treatment approach.

Sponsored by the Patient Empowerment Network, which received educational grants from AbbVie and Genentech.

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Transcript

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.

Andy:  

My name is Andy from Tucson, Arizona, and I’m a caregiver.  I’ve heard so much recently about ibrutinib (IMBRUVICA®) and idelalisib (ZYDELIG®).

It seems like all those patients that are on watch and wait. But when you look at the package insert, it clearly says it’s only indicated for those who have failed one other treatment. So my question is, in the real world that you practice in, and also realizing the high expense, $100,000.00 plus for each drug, how often are you able to actually prescribe one of these new PK inhibitors first-line for somebody who is just coming off of watch and wait? Does that ever happen?

Andrew Schorr:                  

Yeah.

Andy:    

Or is that desirable?

Andrew Schorr:                  

First line, who wants to take that one?

Dr. Jain:                 

So it is absolutely correct that these agents are approved in the relapse setting. So you probably have to fail some treatment to get ibrutinib or idelalisib, except if you have deletion 17P, then you can get ibrutinib right away. So if a patient is first-line treatment, meaning that they were on watch and wait for some time, and now you need treatment, these agents are not commercially available.

It will be very, very expensive if you want to pay out of pocket for these agents.  So at that time, if you are not a part of the clinical trials, or if you want to get just standard-of-care approach, would be the patients who are younger patients to say, when I say younger, I mean patients [who are intolerant to] chemoimmunotherapy, then FCR is still the standard.  So if someone is 50 years old, 45 years old, they just failed, they were watch and wait, then FCR is still the standard of care. 

If you’re in the older age bracket, you are 75 or 80 years old, or you have co-morbidities, your kidney function is not good, you have some other issues, then I think therapies based on chlorambucil, chlorambucil plus obinutuxumab, which is the new rituximab (Rituxan®) per se, would be considered standard of care. And again, if you have deletion 17P, then for sure, ibrutinib is the standard of care.

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 June 18, 2015