[ Inglês] How Do CLL Inhibitor Treatments Work?

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Topics include: Treatments

How do inhibitors work?  Dr. Nicole Lamanna, a CLL expert at Columbia University Medical Center, explains ibrutinib (Imbruvica), idelalisib (Zydelig) and venetoclax (Venclexta).  Dr. Lamanna answers the question, “What are we inhibiting?” and goes on to define these oral treatments, including for whom they are approved.  Listen as Dr. Lamanna gives insight into how your doctor decides which drugs to prescribe.

Provided by CLL Global Research Foundation, which received support from Acerta Pharma, Gilead Sciences, Inc., Pharmacyclics, Teva Pharmaceutical Industries Ltd and TG Therapeutics, Inc. and the Patient Empowerment Network, which received support from AbbVie Inc. and Genentech Inc. It was produced by Patient Power in partnership with The Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center.

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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. 

Andrew Schorr:

So let’s go on. And then now we get into these inhibitors. So, Nicole, what are we inhibiting? What are we inhibiting?

Nicole Lamanna:                

So as we were saying before, as we’ve been starting to learn about the biology of the CLL cells, there happens to be a whole pathway about how the CLL cells develop. And there are proteins that are involved in sort of the survival of the CLL cells. And I’m trying to make this as basic as I can, so stop me or ask questions if you need to. But there [are] many proteins that are responsible for your CLL cells living and thriving. And so now we’re learning about each of those proteins. And not only do they have an implication in CLL, but other lymphomas, and even other cancers. And so we’re targeting some of these proteins. So again, kind of a little different than the monoclonal antibodies that are targeting CD20, and are targeting that particular protein. We’re targeting some other proteins that are involved. 

And so these inhibitors are each a little different by focusing on a different protein along one of these very significant pathways that are involved in your CLL cells, and actually normal B cells. And so we can talk about each of them if you want. 

Andrew Schorr:                  

Right. So these are approved in the U.S., and you can see, again, the generic name and the trade name as well. Okay. So you now have these to decide. Typically, they’re used for people who’ve already had other treatment?

Nicole Lamanna:                

So up until recently, these were all—so I’m gonna just quickly go through some of them, but I know we’ll talk more about them. So Ibrutinib was the first to be approved. That is what they call IBTK, or ibrutinibkinase inhibitor, initially improved for patients with relapse, so people who have already received prior therapy or patients with a 17P deletion. Obviously, as more and more data has come to light, now this is recently approved for all patients regardless, whether you are untreated or not, with CLL.

So you can now get ibrutinib (Imbruvica) untreated or previously treated. Idelalisib (Zydelig) is what they call a PI3 kinase inhibitor, so a different protein, that is approved only in relapsed patients in combination with rituximab (Rituxan). And venetoclax is a Bcl-2 inhibitor. This is just recently approved. Actually, a couple weeks ago? 

Andrew Schorr:                  

Just a few weeks ago, yeah.

Nicole Lamanna:                

A couple of weeks ago for patients who have had previously treated 17P deletion. So that’s the current indication. So yes, they are all approved but slightly different.

Andrew Schorr:                  

Okay. And we saw with ibrutinib that now it’s available and approved and hopefully paid for for a wider group of CLL patients. 

Nicole Lamanna:                

Correct.

Andrew Schorr:                  

What about these other drugs being used more widely and approved and paid for? What about that?

Nicole Lamanna:                

So do you want me to talk about the approval process or?

Andrew Schorr:                  

Well, just, I mean, is that usually what happens in cancer?

Nicole Lamanna:                

Yeah. So I think one of the things that is very important, and many of you know this who are with me. First of all, when we talk about some of these new agents, first we have to figure out if it’s the right drug for you. But second of all, because these are oral therapies, it’s very different than intravenous chemotherapy. We usually actually—Chrissie can speak more about this greatly. We usually have to—a prescription, when you take an antibiotic or your other medicines to your pharmacy, we actually have to go through specialty pharmacies that exist throughout the country.

There [are] about four or five specialty pharmacies who deal specifically in cancer drugs. And so we actually have to go through them first, find out if you’re approved for the drug. Even though I just told you the indications of why they’re approved, we have to make sure your insurance company approves them and then what your copay might be. And so obviously, this could be an issue for some individuals—not many, but there are a handful where their copay may be extremely prohibitive 

Where maybe they don’t have a pharmaceutical—and I’m really ignorant about all the insurance stuff, because many people have lots of different types of insurance in addition to Medicare, and supplements, and things like that. So we really go through that first step process. Because these drugs are very, very expensive. These medications can cost anywhere from seven to $8,000 a month. And so for us to go through this can be—obviously, if this right now, since you’re taking these as oral therapies, and you could be taking them indefinitely, that can add up. So it’s really, really important that when we go through this process, first we see whether or not someone is approved for this, talk about the copay and whether that’s prohibitive.

The good news is, for most individuals, there are support systems, meaning through the sponsors of some of these new drugs and through insurance companies, where the majority of patients can get these drugs. Their copay is somewhere between zero and maybe $50 a month. But there are a handful where it could be prohibitive.

And that may change their therapy. Hopefully, this will change, because there are obviously a lot of patient advocacy groups and so on and so forth, Leukemia & Lymphoma Society, that we’re really trying to see that they really need to hammer down to get these prices that are affordable for patients, particularly as our patient population in general is aging. And it’s not just for cancer. I mean, think about not just CLL, but other cancer therapies and other therapies in general for other medical problems. So it’s gonna be an important issue.

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 11, 2016