What Options Are Available for CLL Patients Who Relapse After Ibrutinib?

Published on

Topics include: Ask the Expert

During this Ask the Expert segment, Dr. Richard Furman, from Weill Cornell Medicine, answers a question that many Patient Power community members are asking about, “What treatment options are recommended if patients relapse on imbrutinib (Imbruvica)?” Dr. Furman responds by explaining what prognostic factors may indicate a chronic lymphocytic leukemia (CLL) patient is at risk for progression on ibrutinib and treatments that have had promising responses after a relapse. Watch now to find out more.

This is a Patient Empowerment Network program produced by Patient Power. We thank AbbVie, Inc. and Pharmacyclics for their support.

View more programs featuring and

Produced in association with

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.

Is it working for most people, and what are some reasons why it doesn't work for everyone?  And then what treatment options do you recommend if they relapse on Imbruvica?  

So there are certain things that do indicate patients are likely to progress on ibrutinib, not likely progress must but who may progress, and people who might need something more, and that's where a lot of our current clinical are research is focused.  So patients who have a risk of developing a Richter's transformation or patients who have a likelihood of developing a BTK mutation that might generate resistance to ibrutinib are the two groups of people that we worry about most.  

17p deletion is probably the most important predictor for predicting those patient outcomes.  There are other things that are predictive as well like having a NOTCH mutation.  Those are all readily obtainable prognostic markers that allow us to determine who's at risk and who's not at risk for progressing on ibrutinib.  If you don't have 17p deletion or NOTCH1 mutation you have almost a 99 percent chance of being free from progression at five years on ibrutinib.  And it looks like most of the people who are going to progress will progress within five years.  So I think making it to that five?year mark is really very—is the most important thing. 

Venetoclax (Venclexta) works very effectively in patients who progress on ibrutinib, generates some very, very deep responses and very long-lasting responses.  So that's certainly one option.  Another option is to be treated with a PI3-kinase inhibitor.  So we have idelalisib (Zydelig) and duvelisib (Copiktra) now approved.  We will shortly have umbralisib approved as well as a novel agent.  We also have a whole array of other agents coming down the pipeline looking specifically at means for progression on venetoclax.  So we have an MCL1 inhibitor which targets the protein that's likely responsible for resistance to venetoclax.  So all these things are actually currently in clinical trials and certainly will hold a great deal of promise.

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.

Related Programs

An Expert’s Perspective on the Expanded Approval of Venetoclax

Dr. Susan O’Brien discusses the exciting new data propelling the recent approval for the expanded use of venetoclax and the impact it will have on those living with CLL.

Published:

Ask the Expert: Does CLL Return More Aggressively After Relapse?

From our Ask the Expert series, Dr. Michael Keating of MD Anderson Cancer Center answers a viewer’s question: “Does CLL return more aggressively after relapse than it was initially?”

Published:

Mark’s CLL Journey: FCR to Combination Therapies to Transplant

CLL patient and advocate Mark Silverstein shares his experience with several different therapies and the unanticipated challenges he faced on his treatment journey.

Published:

Advertisement
Join Our Community Register for Events Read Our Latest Blog
Advertisement

Page last updated on September 9, 2019