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Esther Schorr:

So we're going to drop you right in here.  What I was talking about that I heard from a number of the researchers and clinicians say is that there's a discussion going on about how absolutely critical is getting somebody to MRD?negative state, or are we—are you all at a place where it may be acceptable or a reasonable thing to say we're going to get somebody as close to not being able to find their disease and then figure out what treatments along…

Dr. Lamanna:

Yeah, yeah, yeah, yeah.

Esther Schorr:

…the way.  Okay.  So now you do it.  You do it. 

Dr. Lamanna:

I mean, obviously this was probably the hottest topics that we really talked about during the meeting, and there were several presentations that were looking in frontline because I think for untreated patients who are getting therapy that's where this burning question comes, and relapse is a little different.  

But in the frontline therapy there were several presentations… 

Andrew Schorr:

For CLL.  

Dr. Lamanna:

…for CLL.  

Esther Schorr:

Okay.  

Dr. Lamanna:

You were talking about other diseases.  

Esther Schorr:

Yeah, we were.  

Dr. Lamanna:

You guys are busy today. For CLL looking at minimal residual disease, looking at combinations with novel agents, to combination chemotherapy, chemoimmunotherapy with ibrutinib (Imbruvica), chemoimmunotherapy with venetoclax (Venclexta), looking at levels of MRD detection, and certainly in these frontline studies there was a lot of significant proportion of patients achieving MRD negativity.   

So I think one of the things that we're looking to do is if—whether that be, and how we get there is obviously—it was like alphabet soup during the meeting, there were multiple different regimens, and certainly that we don't have the answer to yet, but if you can achieve that then there might be ways to truncate the oral therapies so that you're not on indefinite therapy.  That was one strategy that we are all looking at. 

Another strategy would be can you truncate how much chemoimmunotherapy if you're going to use any chemoimmunotherapy in the frontline.  And certainly for favorable patients, so the MD Anderson data was looking at whether or not for favorable subgroups doing something like that would lead maybe even perhaps to a curative strategy.  I use the word "cure," but looking at that data that they did many, many years ago at the mutated favorable folks, 13q deletion, can you enhance that by adding some of the orals and truncate chemoimmunotherapy with fludarabine (Fludara) and cyclophosphamide (Cytoxan) or obinutuzumab (Gazyva), a couple of cycles, then looking at MRD and getting those patients really to a cure.  So MRD was a very hot topic for ASH this year.  

Esther Schorr:

Okay.  So did I—did I understand then too that part of that discussion was that there may be some groups of patients, whether it's CLL or in some of the other blood disorders, that if you can't get them to MRD?negative on first line that what may happen is that as new treatments are developing that there is sort of this chronic treatment regimen that can happen for somebody if you can't get them to…

Dr. Lamanna:

...sure.  I think there is two issues with that.  One is can you continue, right, because if they're in a complete response but still have detectable disease…

Esther Schorr:

Right.  

Dr. Lamanna:

…can you continue whatever oral therapy they're on.  So that's one possibility.  I don't know if you want to consider that a maintenance or just continued therapy. Or let's say that they do get a break, so they've gotten whatever, you know, they were in a complete response but you're watching and they still have residual disease by MRD levels can you then incorporate some other therapy or do something and tailor the therapy.  So I think there were more than one—more than one avenue that's being explored that hopefully we'll have. Some of them are just continuing the therapy, following MRD levels and seeing if they can push those responses to MRD negativity.  Others were looking at whether or not you can follow that and then employ other agents down the road.

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.