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Emerging Chronic Lymphocytic Leukemia Therapies

Panelists:Alessandra Ferrajoli, MD, The University of Texas MD Anderson Cancer Center; Richard R. Furman, MD, Weill Cornell Medical College; Thomas J. Kipps, MD, PhD, UC San Diego Moores Cancer Center; Shuo Ma, MD, PhD, Northwestern University Feinberg School of Medicine, Susan M. O’Brien, MD, UC Irvine Health; William G. Wierda, MD, PhD, University of Texas MD Anderson Cancer Center
Published: Thursday, Apr 14, 2016


Transcript:

William G. Wierda, MD, PhD:
Well, thank you. This has been a great discussion this afternoon. We've reviewed a lot and discussed a lot of information about the latest treatment for patients with chronic lymphocytic leukemia. Before we end today's discussion, I'd like to hear from each of you your final thoughts on the most exciting novel agents that are being presented here at ASH 2015. Let's start with Dr. Ferrajoli.

Alessandra Ferrajoli, MD: My interest in this ASH 2015 meeting is to keep an eye on the new agents. In particular, there is emerging data of immune-modulating antibodies. There is the anti-PD1 antibody, pembrolizumab, that has shown activity in lymphoproliferative disorder. This will be shown by Dr. Wei Ding, and interestingly, it shows some activity not only in CLL, but also in Richter transformation. This opens the page for a new set of agents that are really having great success in a wide spectrum of neoplasms.

William G. Wierda, MD, PhD: Dr. Kipps?

Thomas J. Kipps, MD, PhD: It's obviously a very exciting time with the advent of these newer agents, and one can only imagine the sequencing of these agents and how they might affect therapy or combinations of therapy. And I share with Dr. Ferrajoli, the newer agents that are coming out—newer antibodies affecting binding to different targets that could allow us to have therapy that could either be additive if not synergistic with these new agents—is very exciting. Because, ultimately, we would like to be able to treat our patients safely and have a large number of them actually be cured of their disease. I think that would be quite exciting. And I do think that that goal is not unrealistic, and I don't think we should fall short of that goal.

William G. Wierda, MD, PhD: Dr. Ma?

Shuo Ma, MD, PhD: I think it's very exciting to see many novel agents coming out. With the second-generation BTK inhibitors, or the second-generation PI3 kinase inhibitors, and also venetoclax, the BCL-2 inhibitor, that can offer very deep and durable responses and the possibility of allowing patients to come off therapy with a drug-free period and then potentially be retreated with the same medication. So, all of those novel agents are very exciting.

William G. Wierda, MD, PhD: Dr. Furman?

Richard R. Furman, MD: These novel agents really have had a dramatic impact on how our patients have done. One of the new novel agents that I think is also very interesting is ACP-196, which is also called acalabrutinib, which is a second-generation BTK inhibitor that is more specific in terms of binding to BTK without binding to other enzymes and hopefully will show us diminished risks of diarrhea, bruising, atrial fibrillation, and hypertension. We're going to start to see at ASH 2015 some early efficacy data, which will be very intriguing. It's also not metabolized by the CYP3A4 system. So we may finally have a way to avoid some of those drug-drug interactions that we had discussed earlier.

William G. Wierda, MD, PhD: Right, thank you. So, on behalf of our panel, we thank you for joining us and we hope you found this peer exchange discussion on CLL to be useful and informative.

Transcript Edited for Clarity
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Transcript:

William G. Wierda, MD, PhD:
Well, thank you. This has been a great discussion this afternoon. We've reviewed a lot and discussed a lot of information about the latest treatment for patients with chronic lymphocytic leukemia. Before we end today's discussion, I'd like to hear from each of you your final thoughts on the most exciting novel agents that are being presented here at ASH 2015. Let's start with Dr. Ferrajoli.

Alessandra Ferrajoli, MD: My interest in this ASH 2015 meeting is to keep an eye on the new agents. In particular, there is emerging data of immune-modulating antibodies. There is the anti-PD1 antibody, pembrolizumab, that has shown activity in lymphoproliferative disorder. This will be shown by Dr. Wei Ding, and interestingly, it shows some activity not only in CLL, but also in Richter transformation. This opens the page for a new set of agents that are really having great success in a wide spectrum of neoplasms.

William G. Wierda, MD, PhD: Dr. Kipps?

Thomas J. Kipps, MD, PhD: It's obviously a very exciting time with the advent of these newer agents, and one can only imagine the sequencing of these agents and how they might affect therapy or combinations of therapy. And I share with Dr. Ferrajoli, the newer agents that are coming out—newer antibodies affecting binding to different targets that could allow us to have therapy that could either be additive if not synergistic with these new agents—is very exciting. Because, ultimately, we would like to be able to treat our patients safely and have a large number of them actually be cured of their disease. I think that would be quite exciting. And I do think that that goal is not unrealistic, and I don't think we should fall short of that goal.

William G. Wierda, MD, PhD: Dr. Ma?

Shuo Ma, MD, PhD: I think it's very exciting to see many novel agents coming out. With the second-generation BTK inhibitors, or the second-generation PI3 kinase inhibitors, and also venetoclax, the BCL-2 inhibitor, that can offer very deep and durable responses and the possibility of allowing patients to come off therapy with a drug-free period and then potentially be retreated with the same medication. So, all of those novel agents are very exciting.

William G. Wierda, MD, PhD: Dr. Furman?

Richard R. Furman, MD: These novel agents really have had a dramatic impact on how our patients have done. One of the new novel agents that I think is also very interesting is ACP-196, which is also called acalabrutinib, which is a second-generation BTK inhibitor that is more specific in terms of binding to BTK without binding to other enzymes and hopefully will show us diminished risks of diarrhea, bruising, atrial fibrillation, and hypertension. We're going to start to see at ASH 2015 some early efficacy data, which will be very intriguing. It's also not metabolized by the CYP3A4 system. So we may finally have a way to avoid some of those drug-drug interactions that we had discussed earlier.

William G. Wierda, MD, PhD: Right, thank you. So, on behalf of our panel, we thank you for joining us and we hope you found this peer exchange discussion on CLL to be useful and informative.

Transcript Edited for Clarity
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