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Dr. Chavez on Ongoing Efficacy and Challenges With Ibrutinib in CLL

Julio Chavez, MD
Published: Tuesday, Aug 01, 2017



Julio Chavez, MD, of the Department of Malignant Hematology at Moffitt Cancer Center, discusses the ongoing efficacy but also challenges with ibrutinib (Imbruvica) as treatment for patients with chronic lymphocytic leukemia (CLL).

Ibrutinib has changed the landscape of treatment entirely for CLL, Chavez explains. While it is an oral agent that is generally well tolerated, there are some toxicities to consider. These include increased bleeding, atrial fibrillation, and infections. Those are manageable but can lead to potential comorbidities, he adds. The efficacy of ibrutinib is impressive in many CLL settings, such as high-risk patients, those with 17p deletion, elderly patients, those with treatment-naïve disease, and relapsed/refractory patients.

However, there are some issues as the complete remission rates are less than 10%. It doesn’t increase with combination therapy, whether rituximab (Rituxan), bendamustine and rituximab, or chemotherapy is added, Chavez says. Moreover, deeper remissions are associated with good outcomes in patients with CLL.

Additionally, patients discontinue treatment on ibrutinib for several reasons, such as toxicity or disease progression. Recent data show that if patients progress on ibrutinib, moving to chemotherapy or monoclonal antibodies is no better than going to agents, such as idelalisib (Zydelig) or venetoclax (Venclexta). If patients fail on ibrutinib, the next step should be venetoclax.
 


Julio Chavez, MD, of the Department of Malignant Hematology at Moffitt Cancer Center, discusses the ongoing efficacy but also challenges with ibrutinib (Imbruvica) as treatment for patients with chronic lymphocytic leukemia (CLL).

Ibrutinib has changed the landscape of treatment entirely for CLL, Chavez explains. While it is an oral agent that is generally well tolerated, there are some toxicities to consider. These include increased bleeding, atrial fibrillation, and infections. Those are manageable but can lead to potential comorbidities, he adds. The efficacy of ibrutinib is impressive in many CLL settings, such as high-risk patients, those with 17p deletion, elderly patients, those with treatment-naïve disease, and relapsed/refractory patients.

However, there are some issues as the complete remission rates are less than 10%. It doesn’t increase with combination therapy, whether rituximab (Rituxan), bendamustine and rituximab, or chemotherapy is added, Chavez says. Moreover, deeper remissions are associated with good outcomes in patients with CLL.

Additionally, patients discontinue treatment on ibrutinib for several reasons, such as toxicity or disease progression. Recent data show that if patients progress on ibrutinib, moving to chemotherapy or monoclonal antibodies is no better than going to agents, such as idelalisib (Zydelig) or venetoclax (Venclexta). If patients fail on ibrutinib, the next step should be venetoclax.
 



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