CLL News From ASCO 2015

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Topics include: Treatments

Patient Power host Carol Preston interviewed Dr. Nicole Lamanna, from Columbia University Medical Center, to learn CLL news from the 2015 American Society of Clinical Oncology (ASCO) meeting in Chicago. Dr. Lamanna explains research announced at the conference, including results of the Phase III HELIOS study, which explored the addition of ibrutinib to bendamustine/rituximab (BR), and its impact on survival. 

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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. 

Carol Preston:

Hello everyone and welcome to Patient Power.  I'm Carol Preston.  We're in Chicago this week at ASCO, the American Society of Clinical Oncology. And with me right now is one of our experts in CLL, chronic lymphocytic leukemia, a disease that I've been living with for almost nine years now, Dr. Nicole Lamanna from Columbia Medical Center. 

Dr. Lamanna, can you bring us up to date on the news of CLL at ASCO?  

Dr. Lamanna:

I think the biggest presentation that we had was from Asher Chanan-Khan regarding the addition of ibrutinib (IMBRUVICA®) to bendamustine (TREANDA®) and rituximab (Rituxan®).  So this was a Phase III study that patients were randomized to receive bendamustine/rituximab either with placebo or with ibrutinib.  These were patients who had prior therapy for their disease, so this was a previously treated group, but the—there [were] approximately almost 300 patients in each arm.

There was definitely an improvement both in progression-free survival, overall response, even in the frequency of complete remissions that we saw with the ibrutinib arm added to bendamustine/rituximab over placebo with bendamustine/rituximab.  So clearly very, very successful salvage treatment regimen from this meeting that was presented by the group showing that the addition of ibrutinib to a combination, a standard combination chemoimmunotherapy program has advantages, and I think we're going be seeing lots more of kinase inhibitors being added to traditional chemoimmunotherapy programs such as this.  

Carol Preston:

So would you consider this a game changer? 

Dr. Lamanna:

It is, you know, I think that there's no doubt that as folks have gone along with receiving, you know, frontline therapy and then different salvage therapies there's no doubt that this is probably one of the first represent—large representations of looking at a kinase plus chemoimmunotherapy in a salvage setting, and so I think there's going to be certainly a shift towards using that now in the salvage setting. 

Of course, we're also going to be keen on looking at these agents with combination chemoimmunotherapy programs in the frontline setting, and obviously many of these trials are either running or closed, and we're going to be looking forward to seeing that data as well.  So for now, yes, I think this is a game changer in the salvage setting, but it will be interesting to see as these agents move up front in the initial therapies how that will then change if subsequently patients then relapse or need a change after their frontline—frontline treatment.  So it will be different. 

Carol Preston:

Now, the researchers ended up using bendamustine, which has been around for a long time.  Any reason, was there any explanation as to why they chose that…

Dr. Lamanna:

Versus…

Carol Preston:

…versus Gazyva or something like that…

Dr. Lamanna:

Yeah, fair enough. 

Carol Preston:

…with a different agent? 

Dr. Lamanna:

I think, you know, the combination of bendamustine and rituximab has been a well-established salvage regimen, and of course we've also looked at that with other traditional, other presentations looking at that versus, let's say, a purine analog like a fludarabine (Fludara®)-based combination. 

Carol Preston:

And I just want to be clear.  Salvage meaning relapsed…

Dr. Lamanna:

Relapsed, sorry.  

Carol Preston:

…or refractory. 

Dr. Lamanna:

Yes, absolutely. 

Carol Preston:

People who have…

Dr. Lamanna:

Absolutely. 

Carol Preston:

…gone through this, down this road before. 

Dr. Lamanna:

Yes, absolutely.  And I think the reason why I think they chose bendamustine/rituximab is because it's such a common treatment regimen to give after frontline therapy, and so I think they said let's choose something that's given very often for patients who have had prior treatment.  That would be bendamustine and rituximab, but one could have made an argument in saying, well, what about all the newer monoclonal antibodies?  Would those have been better if we instead of rituximab used a different monoclonal antibody?  Of course, that could have been a consideration as well. 

But this is a very common treatment regimen to give in the salvage setting, and so I think they made—it just made sense because we see this so often in the community.  So bendamustine really is a go?to for both people who have been—had prior therapies, particularly after purine analogs.  And certainly for older individuals, you know, oftentimes physicians will give bendamustine/rituximab in combination so. 

Carol Preston:

So for patients, and I'm a patient, what does this news mean?  You know, if I'm a patient, what should I be hopeful about? 

Dr. Lamanna:

Yeah.  I think—I think there's a lot to be hopeful about in CLL.  I mean, I think that the last few years, of course, all of you have seen an explosion of these newer agents with the small molecule inhibitors.  You've seen the explosion of new agents, and now we're all trying to put that into some context for you all about, you know, what's the right way to sequence these drugs, how do we use them?  Can we use them safely with traditional chemoimmunotherapy program programs?  [Is] there an advantage to doing that?  And this is what this study showed, that there was an advantage to adding ibrutinib to a combination chemoimmunotherapy program. 

So I think as we go along there's going to be a lot more hopefully data that will sort of clarify some of these issues and see if somebody is newly treated do we start with a kinase?  Do we start with a traditional therapy?  Do we start with a combination of more than one kinase or with combination chemoimmunotherapy program?  And then what do you do if people relapse after that? 

So I think you're going to see lots of different focus on the small molecule inhibitors, whether with and without, and hopefully we can answer some of the questions about sequencing and obviously improve the lives of patients with CLL, either having their progression?free survival prolonged, their time to next treatment, their reduction of death, side effect profiles.  I think there's a lot we're going to be learning over the next few years. 

Carol Preston:

Well, Dr. Nicole Lamanna, first of all, we thank you so much for the work that you are doing to help we who have CLL to sort out these options and make sense of it.  It's a very encouraging time, but also a little bit confusing too…

Dr. Lamanna:

Yeah, fair enough.  

Carol Preston:

…so we'll be looking for an update from you from ASH in December, the American Society of Hematology.  Nicole Lamanna from Columbia Medical Center, thank you again. 

Dr. Lamanna:

Thank you very much. 

Carol Preston:

I'm Carol Preston.  And remember that 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 March 13, 2017