Clinical Research Updates on CLL Frontline Therapies

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Topics include: Treatments

During this Ask the Expert segment, a Patient Power community member writes in, “Are approaches for first-line treatment likely to change in the next couple years?” Renowned chronic lymphocytic leukemia (CLL) expert Dr. Jeff Sharman, from The US Oncology Network, responds by explaining what options are available for frontline treatment, some pros and cons for treatment choices and factors to consider when finding a suitable therapy. Dr. Sharman also shares compelling clinical trial research on therapies used in the frontline setting. Tune in to find out more.

This is a Patient Empowerment Network program produced by Patient Power. We thank AbbVie, Inc. and 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.

Andrew Schorr:

Here's another question from Bob.  Bob wants to know, will approaches likely change for first?line treatment, for instance venetoclax, or Venclexta, within the next two years?  You have ibrutinib (Imbruvica) first line.   

And per the prior question, some patients have difficulties with that, whether it's arthralgias or bruising bleeding and so forth.  The medication you made mention of I think is the frontline therapy that may have the most profound impact on treatment selection in the next two years.   

Andrew Schorr:

Venetoclax.

Dr. Sharman:

So the German Research Group, which is really just absolutely one of the best out there, have fully enrolled a clinical trial of obinutuzumab (Gazyva) venetoclax versus chlorambucil and obinutuzumab, and I have to believe that that is going to result in a superior outcome for the venetoclax arm and that we will have the combination of obinutuzumab venetoclax for front?line setting.

And what's really appealing about that is that is one year of treatment and then treatment is suspended and stopped.  And though we haven't compared that to more traditional BR or FCR, I think it would be a highly effective regimen.  We are currently conducting a study in the United States in our research network looking at the combination of obinutuzumab and venetoclax, and what I like about our study is we give—for the listeners who might not be familiar with venetoclax, starting venetoclax is a little bit clunky because it works so quickly we have to be careful about a condition called tumor lysis syndrome, which is if you kill too much cancer cells too quickly that can cause some dangerous conditions, and venetoclax does do that.  

And so what we're doing is we're giving two months of obinutuzumab and sort of getting rid of the bulk of the CLL and then starting the venetoclax hopefully under much safer conditions, because, you know, in the Pacific Northwest we would say you can't have forest fires if you don't have any trees.  So if we get rid of all the CLL or a substantial fraction of it somebody is less likely to have tumor lysis.  So I think that's the approach that is probably the next up in frontline.  

The one other thing that could potentially change is acalabrutinib has conducted a three?arm study??excuse me, Acerta with acalabrutinib (Calquence), where they give—it's a three?arm study with either chlorambucil Gazyva, acalabrutinib or acalabrutinib with Gazyva.  And so does the addition of a C?20 antibody make BTK work better, remains the question outstanding.  

The challenge with that approach is it's not approved in that combination and probably not going to be approved in the next two years unless the FDA does something that maybe I'm not anticipating at this point.  That clinical trial that compares that to an existing standard is really only just getting off the ground now.  

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 May 14, 2019