[ Englisch] CLL Combination Therapy News From ASH 2017

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Topics include: Treatments

Can today’s medicines be used together to treat CLL more effectively? CLL expert Dr. Michael Choi of UC San Diego Moores Cancer Center joins Patient Power’s Andrew Schorr at the 2017 American Society of Hematology (ASH) conference. Dr. Choi provides an update on current medicines and discusses promising combination therapies for CLL, including research into combining ibrutinib (Imbruvica) and venetoclax (Venclexta).

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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 on location in Atlanta at the American Society of Hematology meeting.  Thousands of experts from around the world here and a lot of research being presented.  For those of us with CLL, we wonder can powerful medicines be used together for a bigger bang, if you will.  One of the investigators looking into that is with me, Dr. Michael Choi from UC San Diego.  Thank you so much for being with us. 

Dr. Choi:

Oh, thank you.  Happy to talk. 

Andrew Schorr:

So Imbruvica or ibrutinib, Venclexta or venetoclax, both very powerful with a lot of utility in CLL.  Some of you out there may be getting one of them, but you and other centers have been looking into using them together.  What are we hearing? 

Dr. Choi:

Oh, yes.  I just left a session where I would say a half of the talks were on combining venetoclax or ibrutinib with other drugs or together, and I could say the results are truly exciting.  I think for really the first time with these novel therapies we're seeing trial results where the majority or the vast majority of patients are getting complete remissions, MRD-negative remissions, finite durations of therapy with remissions afterwards. 

So I think this is a truly exciting advancement.  The groups that presented showed that there wasn't unmanageable toxicity, that tumor lysis syndrome wasn't a major concern, and so I think it's a great advancement for patients with CLL. 

Andrew Schorr:

Now, Dr. Choi, you just mentioned something about the duration of therapy.  So those of us who have had FCR, we had that and then it finished, and hopefully we got a long remission, and some other therapies, BR. But with some of these oral therapies the question was, especially with expensive medicines, do we have to keep taking them forever?  So there any indication with this combination that some people might be able to stop? 

Dr. Choi:

I think the results are early still, but so far it looks like especially the patients that got MRD-negative remissions, that most of them were still in remission afterwards.  So I think while we still want to prioritize progression-free survival, or we want to prioritize keeping patients well for as long as possible, it looks like these strategies may allow us to accomplish that without remaining on therapy for that whole time. 

Andrew Schorr:

Okay.  And that's a question.  So first of all just explain, MRD negative is minimal residual disease negative, can't find it.  So the question would be if you and your doctor decide, well, you can go off therapy.  If we needed it again, could we get back on it without a penalty? 

Dr. Choi:

That's what—that's what we think makes sense logically, that if the disease had not become resistant to that drug it should respond again when treatment is restarted.  At UCSD, we have had one of our own patients in that scenario where we had—we decided to restart venetoclax in her case after the disease came back and again had an excellent response.  So I think it is something we are expecting. 

I guess the trial that I'm part of at UCSD, that we're a part of at UCSD we'll look at that formally where patients will receive ibrutinib and venetoclax as a combination for about a year-and-a-half and then will be followed pretty closely.  And then upon—for patients that had a MRD-negative complete remission if things relapse, those patients will be restarted on therapy on trial so that we could really formally capture those responses and what the response rate will be. 

Andrew Schorr:

Okay.  Well, this is an exciting time related to combination therapy, which has worked a lot in chemotherapy.  We all know that.  And it's worked in other cancers.  Can combination therapy with new novel oral medicines be the biggest bang of all?  And also as Dr. Choi was saying, can it mean that you can have therapy for an extended period of time, maybe a year-and-a-half, as you said, get to that MRD-negative point and then stop?  And if you had to go on it again, it could be an effective therapy.  That's what we hope.  So next year maybe we'll know more, right? 

Dr. Choi:

Yeah, exactly.  Yeah, progress every year. 

Andrew Schorr:

Okay.  Well, this is certainly progress now.  Andrew Schorr with Dr. Michael Choi from UC San Diego Moores Cancer Center on location in Atlanta where a lot of news breaks.  Stay tuned with us on Patient Power, be signed up with us so you'll always know whenever we post something new. 

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 January 17, 2018