Dr. Michael Keating: My Perspective on CLL Research News

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Topics include: Treatments

What CLL treatment advances are in the pipeline, and will they be available to everyone soon?  Dr. Michael Keating, a world-renowned expert from MD Anderson Cancer Center, has his finger on the pulse of CLL research.  In this interview, Dr. Keating discusses emerging therapies and clinical trials, and he explores avoiding barriers to improved care.

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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:

Hello and welcome to Patient Power. I’m Andrew Schorr. At the 2016 meeting of the American Society of Hematology or ASH, we caught up with Dr. Michael Keating who is one of the most famous doctors treating patients with CLL. He’s been my doctor, and we asked him from that meeting what was significant for patients.

Dr. Keating:         

I think that there is increasing interest now that we have agents that don’t damage DNA and the immune system that we can see if early intervention may work. So far, we have waited until they have progressive disease and fulfill the iwCLL criteria for treatment before initiating anything. But there’s now evidence that there is a watch-and-wait group that you can fairly confidently predict who will need treatment in the next two or three years.

So do you do good things if you intervene as soon as you get that surety and see if it changes and increases the chance of the disease being cured by the early intervention before resistant clones come along?

Andrew Schorr:

So we asked Dr. Keating when these emerging strategies for the treatment of CLL will be available for patients.

Dr. Keating:         

I think that there are two problems that we face. I’m certain there will be a benefit from the combinations that come along. There will be benefits from understanding the correct dose and schedule. Do we need to give these drugs forever? Is it good to have a drug holiday? A lot of things like this from the patient’s point of view. They get very scared to come off for even a few days, because they think they’ll lose something by doing that, and that’s almost certainly not true.

The other major problem is the uncertainty about healthcare in the United States with the new election and the complications or the complicated process with Obamacare and rising costs of doing that. So that’s one black cloud that’s hanging over the head of patients. And the second is with the cost of these combinations. If you have two drugs that are $100,000-plus a year, what insurance carriers are going to pay for that?

So there are very real questions that come, and it’s an even greater problem with Europe and other advanced countries and impossible to even contemplate for emerging Third World countries as to what’s going to work out there.

The technology of what we know in cancer these days is ahead of our understanding with how to apply it. If you are applying it scientifically, how do you apply it clinically? So there are different stages that we all have to address for the maximum benefit of the patients that really need these treatments.

Andrew Schorr:

We also asked Dr. Keating how patients can work with their doctor, so they can learn more about clinical trials and whether there’s a trial that’s right for them.

Dr. Keating:         

I think that one of the problems that we have is that in the United States, most CLL patients are treated by oncologists. And they have much more of their practice in solid cancers, so they don’t see a lot of CLL patients. So they try their best to keep up with everything that’shappening.

But unless they’re members of a cooperative group, they probably won’t have much access to the clinical trials. But those who are used to mining the Internet can usually find a study of a combination if that’s what the patient is most interested in. But getting the message out is really important as to what the pluses and minuses of these therapeutic strategies are. It’s hard for patients to get to a knowledgeable doctor oftentimes, and it’s more likely to occur if patients are affluent than the average patient that walks into the doctor’s office. 

We’ve got a lot of work to do in providing that linkage from success in clinical trials to how do we get the effective ones out in a cost-efficientfashion to the patients generally. 

Andrew Schorr:

Finally, we asked Dr. Keating how patients who may be in what are so-called underserved populations where they may lack insurance or lack resources, how can they be connected with clinical trials?

Dr. Keating:         

I think there are two things. One is to really prove what the best regimen is so they can champion one thing rather than one company and one group of investigators championing their patent thing. We have to have the discipline that we apply to the clinical trials.

We need to simplify the clinical trials so they are not as cumbersome as they are at the present time. The FCR protocol that we had was 13 pages in total, and now it’s 13 pages for the introduction or the abstract. So there’s so much intensive monitoring that we need to squash down, and it’s really done for the skeptics; you have to prove, etc. The other is that if a protocol leads to approval of a drug, we have to realize that many patients are either not eligible for the drug so there are so many exclusion criteria and so many inclusion criteria that the majority of patients don’t fit into the group that’s investigated. 

So I think that if there is a study that has led to approval, there should be a subsequent study that’s not all that complicated that we address is it bad to have a liver function test abnormal? Is it bad to have had a history of a cancer in the last two years or five years in some situations, so that we can make it amendable to the patients? Part of it is the incredible regulatory burden that the companies and the investigators and the hospitals have for all of these studies.

It really does slow down general access. Because we talk about getting on a clinical trial; a clinical trial is now very cumbersome. They have to have CAT scans at all these prescribed intervals, etc., and the value of doing that is questionable.

They have to come along and have all these tests done at prescribed dates, and some people can’t get babysitters for that sort of thing. Others, the transportation to and from the center that’s running the trial is an additional cost, which is a day-to-day cost and can’t be obviated by just wanting to be in a clinical trial. So there are more socioeconomic challenges, I think, than scientific right now.

Andrew Schorr:

Thanks once again to Dr. Michael Keating from MD Anderson Cancer Center for being with us on Patient Power and keeping all of us up to date. I want to remind you that on February 18th from Houston, Texas and MD Anderson Cancer Center we’ll be broadcasting live to an in-person audience there and wherever you may be in the world to hear the latest. Dr. Keating and Dr. Nicole Lamanna from Columbia University will be with us. Be sure to be signed up, so you get the latest. 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 February 2, 2017