Advances in Treating CLL at Any Age

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Topics include: Treatment

With many new CLL treatments available, can a patient’s age limit the list of available options? Drs. Alessandra Ferrajoli and Nitin Jain, CLL experts from MD Anderson Cancer Center, explore recent progress in treating elderly and difficult-to-treat patients, plus factors that people should consider with their doctor when choosing a treatment.

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

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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.


So we may have an older person that is otherwise fit.  They can receive what you may call a little more aggressive treatment.  But we also may have at times a younger person for which we need to make adjustment.  So I truly feel that an older person has the same options than a younger person has.  They may need to be personalized.  They may need—the therapy may need to be modified but not to the cost of being effective. 

Now, specifically you mentioned about the 17p deletion, and I think that's correct that if you use chemotherapy?based approaches—which we were doing before the targeted therapies because that was the best available, that was not the most optimal therapy.  After FCR treatment, median time that a patient stays in remission is just around a year with 17p deletion. 

But now we are seeing with ibrutinib, idelalisib and other drugs in the pipeline that these patients are getting first remission of the order of three, four years, perhaps longer.  So I think this says the new drugs are remarkable, and especially for patients with deletion 17p.  And I think the issue of transplant, that's another kind of discussion about patients with 17p, but I think these drugs are making a big headway for all groups of patients, older patients, 17p deleted patients, And I think we're going to see gradually in younger patients also in the frontline setting. 

We don't know what the duration is for a patient that receives it as an initial therapy or as their first salvage therapy, and that doesn't have aggressive features.  It's likely to be much longer than two years, just based on how long we have been running those trials.  My educated guess is that it's going to be in the order of several years. 

Now, the development of resistance is a problem, but it seems to be happening in a very, very, very small percentage of patients.  So—and the mechanism that is one of two that have been kind of identified, but not for everyone.  So that is, you know, a field…

It's also true that thinking about what to do if resistance occurs or if, you know, for any reason tolerance, possible side effects—we don't know what the side effects of some of the treatment may be in year four, year five, year six.  If for any reason we need to change therapy, what I tell my patients is similar to what they may tell you in a store or a restaurant.  The menu is getting longer and longer. 

The new CD20 antibodies are also effective, and also we have to think that maybe in the years to come people may use the targeted therapy more as first line.  They may not even be exposed to the monoclonal antibodies.  And then, you know, we have so many other.  We have older development around the cellular therapy, the CAR T cells will likely be refined. 

And I think in the years to come, in the next I think two, three years, four years, I think we're going to see more of immune-based therapies for patients with CLL.  There is already interesting data generated with chimeric antigen receptor therapy, and I think in the next one or two years we're going to see clinical trials with immune checkpoint block inhibitors, PD-1, PDL-1, which are the drugs which are now approved in melanoma setting and some solid tumor setting. 

I think we're going to see those trials coming up, and I think that will be a very interesting combination because those are again based on the fact that you're targeting the immune system of the CLL patients not targeting the CLL cells.  So it's a new phenomenon which already works for patients with melanoma, solid tumors, in some group of patients.  So I think those trials we will have to see.  And those have the potential, potentially the potential of long?term disease?free survival, long?term remissions, possibility of a cure.  But I think the next few years are going to be crucial in that aspect. 

I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all. 

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 November 18, 2015