ASH CLL News 2018: How Could Research Results Impact You?

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Topics include: Treatments and Understanding

At the 2018 American Society of Hematology (ASH) conference in San Diego, Patient Power host and CLL patient advocate, Lee Swanson, is joined by Dr. Kerry Rogers, from The Ohio State University Medical Center, to learn about research developments announced at the meeting. Dr. Rogers explains how results could impact patient care and discusses tools for patient/physician collaboration.

This is a Patient Empowerment Network program produced by Patient Power. We thank Pharmacyclics for their support.

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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.

Lee Swanson:

Hello.  I'm Lee Swanson, and this is the American Society of Hematology conference in San Diego, and I'm happy to be joined today by Dr. Kerry Rogers from the Ohio State University Medical Center.  And you are a CLL specialist.  What at this conference has excited you that patients should know about?  

Dr. Rogers:
I think there are a couple really exciting things at this conference that will be very important for patients.  Probably the most exciting thing, in my opinion, hasn't been presented yet but is being presented later today by one of my colleagues.  And then there's a late?breaking abstract that will be Tuesday that's really exciting.  

And these are studies comparing ibrutinib-based (Imbruvica) regimens to a chemoimmunotherapy regimen.  So that's a comparison of a pill targeted agent with a course of chemotherapy with an antibody, and the exciting thing here is that taking the pill oral targeted agent seems to be doing better for patients in a really important way which is how long people are living without their CLL progressing or returning. 

So this is the first time we've had a large-scale comparison of a chemotherapy to a chemotherapy-free treatment.  And just to go into a little bit more detail, if that's okay, there is a study through a cooperative group called the Alliance, and that is a group that does very large studies at multiple centers in the United States that compared BR to ibrutinib to ibrutinib and rituximab (Rituxan). They found that there is no difference in something called progress-free survival, which is how long people are alive without their CLL returning or causing problems between both the ibrutinib arms, but a substantial improvement between the ibrutinib treatment and the chemotherapy treatment, which is bendamustine (Bendeka) and rituximab.  

So this means that ibrutinib regimens are outperforming chemoimmunotherapy, and that was in people 65 and older.  And I think that's very exciting because it's showing that we can treat CLL more effectively in this way than with BR which is the standard chemoimmunotherapy, and these are all people who are taking their very first treatment for CLL.  

There's a similar study in younger patients comparing FCR to an ibrutinib?based regimen with very similar results.  

Lee Swanson:
Really.  So are we looking at a day when that will become standard of care?  

Dr. Rogers:
I firmly believe that—of course, each individual person needs to select a treatment that's best for them, but I think it is a standard of care now to do an ibrutinib?based treatment rather than chemoimmunotherapy for the majority of people taking a first treatment.  

Now, there are select individual patients who will have a very prolonged benefit from FCR, people who have an IGHV-mutated status, so it's a particular test that shows that these people have just a very nice benefit from FCR, but other than that group it is now the standard to do these ibrutinib?based treatments.  And I think both these studies are what is showing us that this is a standard.  It's definitely the most important thing for CLL I think at this meeting.  

Just to plug how important this is, my colleague, Dr. (?) Wyak, who's presenting the Alliance study, is doing so at the plenary session, and that's the talk where they pick the very, very best kind of studies or data from the entire meeting, so not just CLL but noncancer blood disorders, other blood cancers.  So this is really a very important thing for people with CLL.  

Lee Swanson:
Show how does a patient go about talking to their doctor about these emerging...  

Dr. Rogers:
Yeah, so I think it's really important to be able to ask your doctor anything, and this is something that people should talk with their doctor about. Both these studies were in people taking a first treatment for CLL, but that doesn't mean that this type of finding isn't important to other people.  And I think if you're considering a first treatment for CLL and need a first treatment for CLL I think sitting down with your doctor saying, you know, finding out what they recommend but then also saying, you know, how do you feel about these chemotherapy treatments versus ibrutinib?type treatments and seeing what they have to say.  

And, of course, I think it's very fair since this data is going to be presented at this meeting to ask your doctor about these large studies. These are the type of really big studies that should be understood by the majority of oncologists.  So I think it's okay to ask them specifically, just, hey, what do you think about the studies comparing chemotherapy to ibrutinib? How does that apply to me as a person? 

Lee Swanson:
So chemotherapy of course is a refined, six sessions or generally. Ibrutinib, are they then looking at a prolonged use of ibrutinib?  

Dr. Rogers:
Yes.  So both these studies, the ibrutinib was continued indefinitely which is the way it's supposed to be prescribed in the United States, versus chemotherapy, which is a combination of chemotherapy and then antibody for about six months of treatment, so that is an important consideration.  

Also at this meeting there's data about combination regimens that don't include chemotherapy that are a fixed or limited treatment course, so I think that's also very exciting.  Those studies are now not very far into follow?up, so people have only finished those treatments for a year or so.  I think that when we look at these chemotherapy-free combination treatments we're really going to need to see how long people do really well after they finished treatment to know what the true benefit is, but that's also very exciting to see that happening.  It might allow people to avoid chemotherapy, stop treatments and get very good remissions that last years and years.  We just haven't had them long enough to know the years and years yet like with some of the chemotherapies.  

Lee Swanson:
Of course.  So one of the—one of the things about CLL is that it finds a way around treatment often. They clone cells or what-have-you that then, you know, so you're looking then at second- or third-generation medications sometimes.  

Dr. Rogers:
Yes, that's true.  

Lee Swanson:
So that's going to be a continuing challenge. 

Dr. Rogers:
Yes. I think that is a continuing challenge, and when we see more of these people taking these oral targeted agents, these pill treatments that aren't chemotherapy that are taken for an extended period of time we're going to see more people where those treatments stop working or develop resistance, and just because we've now shown it's superior to chemotherapy-based treatments as a first line doesn't mean that these are perfect. So we are still working very hard on what to do after you take something like an oral targeted agent for first treatment or even a second treatment or a third treatment.  There's a lot of research at this meeting being presented in that area, too.

We've shown venetoclax (Venclexta) works well after ibrutinib, but we still are trying to get a handle on has works well after venetoclax.  There's some kind of laboratory?based data around venetoclax resistance being shown at this meeting, and I think that's going to be important too, because that's what helps us build better treatments for those people is to really take a deep look at what's happening on a cellular level in the leukemia.  

The thing I actually saw this morning that I thought was very exciting for people who might have developed resistance to one or more targeted agents is actually CAR?T therapy.  I think that the more I've seen data coming out with that the better it's getting, the better we are getting at giving that to people.  And while that is definitely not therapy right now for the majority of CLL patients there are definitely some people that benefit from that type of treatment that have participated in research studies with it.  And I think that's something that's going to advance and fill some of the need for what we're going to ideally offer people who have had their CLL come back on these targeted therapies.  

Lee Swanson:
So CAR?T, it's worked very well for some people.  It's worked not at all for other people.  Is there a way to be able to target who's who?  

Dr. Rogers:
You know, I really hope so.  Right now I don't know that we've come up with a firm to target who's going to benefit the most and who's not going to benefit, but I do think the more experience we get with that the more we're going to learn about not only who will benefit but also how to make it so more people benefit. So going in, instead of saying X many people benefit, have a higher percentage of people that undertake it do well with it and to have the side effects of it reduced.  You know, that's not a fun and easy treatment, so I think the continued work to reduce the side effects and also get it to work for more people is going to be really important.  

Lee Swanson:
Well, thank you very much for your time.  We really appreciate it, and it's very good to talk to you.  Thank you.  

Dr. Rogers:
You're very welcome.  

Lee Swanson:
I'm Lee Swanson at the ASH conference in San Diego.  

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 December 24, 2018