Does a Standard of Care Still Exist for CLL Patients?

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Topics include: Treatment and Understanding

Is there a standard of care when it comes to treating CLL patients? Patient advocate Jeff Folloder poses this question to CLL experts Dr. John Burke and Dr. William Wierda.  The panel explains the current approaches to standard treatment, the role of FCR (fludarabine, cyclophosphamide, rituximab) and the criteria used to start treatment. 

This program was made possible by Pharmacyclics LLC and Janssen Biotech, Inc. Produced in partnership with Rocky Mountain Cancer Centers.

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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. 

Jeff Folloder:

Understood. So there things right now all standard therapies. The standard of care still exists for CLL things like FCR bendamustine (Treanda) and others is there still a standard care of, “Here, off the shelf?”

Dr. Burke:            

I think the answer is yes, there is not necessarily one single standard that fits all. But there are several treatments that are considered standard options for patients who are not going on to clinical trials. Those would include the FCR regimen,

and then the bendamustine and the rituximab (Rituxan) regimen, and then various treatments for true patients that relapse as well. So I think there are a number of standard treatments available.

Jeff Folloder:     

Dr. Wierda, when I was first diagnosed with CLL almost 8 years ago, my hematologist wanted to go immediately to FCR who wanted to start me the very next day I saw a second opinion at Anderson and I was told, “Stop. Don’t do that.” Why doesn’t FCR work for everybody? Why isn’t it boom, yeah, just do it?

Dr. Wierda:          

So I think you’re asking two different questions. One is in terms of management and starting treatment right away versus having patients monitored with observation. And why do we do monitoring and observation versus when do we start treatment?

The criteria that we use and the guidelines that we use to start treatment haven’t changed.

The international working group for CLL is updating the guidelines and interestingly, the indications for treatment are not changing in the new update. So we still use the same criteria to determine when a patient needs to start treatment. Those are things like a low hemoglobin, below 10, a low platelet count below 100,000, or disease-related symptoms that you want to go away with effective treatment.           

So if patients don’t have those features, don’t meet the criteria to start treatment, the recommendation is for monitoring and observation—unless there’s a clinical trial that we’re interested in enrolling a patient in, and they have some feature that makes them high risk for needing treatment sooner. And we’re asking a question with a new treatment, which would be given on a clinical trial in terms of what to pick for the first treatment. There are a lot of factors that go into picking what the treatment is the proper treatment is for a particular patient.                 

You used the example of FCR. FCR is a highly effective treatment. We learned a lot, because we’ve been using FCR for 20—almost 20 years, and we’ve learned what the long-term follow-up that we have that is most effective in patients who have particular characteristics were younger, who can tolerate the toxicities that we see with FCR. So it today more than ever, there are as you say standards and standards are relayed to me effective treatments.         

Treatments that have been shown to be very effective. We have a lot of different standards. Now we have more standard treatments available than we ever had and the challenges more to personalize and individualized treatment with patients in order to achieve best outcomes for a particular individual patient.

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 14, 2017