Panelists: Krishna V. Komanduri, MD, Sylvester Comprehensive Cancer Center; Leo I. Gordon, MD, Robert H. Lurie Comprehensive Cancer Center; John Byrd, MD, Ohio State University; Michael Keating, MB, BS, University of Texas MD Anderson Cancer Center; John Leonard, MD, New York-Presbyterian Hospital
Krishna V. Komanduri, MD: So, we’ve had a really great discussion. I want to thank all of the panelists. It’s been extremely informative. And before we complete our time today, I’d really like to get some just final thoughts from each of our panelists. We’ll go down the row. John?
John Byrd, MD: We’re clearly, at ASH 2016, seeing the fruits of a lot hard work on the part of investigators who wrote trials and, most importantly, the patients that contributed to them. We’re seeing long-term follow-up now with these new targeted agents that really give us a lot of promise in the future for CLL, except for the patients where we’re potentially doing curative therapy with FCR-based regimens and where we might be able to move away from chemotherapy for the majority of our patients. And, to me, that’s the most exciting thing.
Leo I. Gordon, MD: Yes. And I would say, as we begin to learn about the molecular biology of these diseases, all the research that has gone on has really translated into major advances in lymphomas, in both the diffuse large B-cell lymphoma and follicular lymphoma. Our better understanding of the molecular biology will really lead to major shifts in the way we approach these. I think it’s a great era. I wish I were starting over.
Krishna V. Komanduri, MD: I would add, before going to John, that one of the things that’s really a topic of conversation is that we’re seeing convergence across diseases, right? And I think that states that there are a lot of similar concepts of combining novel agents with historical agents, like antibodies and chemotherapy with CAR-T cells. I think rather than thinking about individual diseases, we’re thinking about modalities of therapy that can be used synergistically.
John P. Leonard, MD: I think that’s just a reminder that we need to continue to focus on our goals of therapy. It’s easy when we’re extending survival. It’s measurable if we’re improving progression-free survival or curing patients. But the quality of life for the patient is really key. And the progression-free survival without overall survival scenario, maintenance treatments that people are going to be on for a long time that have side effects, that question—which I think you framed earlier—is harder in the 6 months. You’re getting FCR; it may catch up with you later, but you may do great for many, many years or decades. On the other hand, something like ibrutinib could be easier in the short term for most people, not bad in the long term for most people, and annoying in the long term for some people. How do you balance that out in a way that is not focused on our biases, as a physician, of what we think is best for our patient? How can we more objectively present to a patient in a way that results in the right decision for them? I think that is what we’re tasked with.
Michael J. Keating, MB, BS: A few of us just wrote a little editorial at MD Anderson for distribution, and basically, the message was: don’t forget about chemotherapy. It’s very sexy to have the targeted therapies, but CHOP has been a fundamental chemotherapy drug from the early 1970s and it has done a pretty good job. So, don’t throw out the baby with the bathwater.
Krishna V. Komanduri, MD: Great closing comment. Thanks to all of you for your contributions to this discussion. On behalf of our panel, we thank you for joining us and we hope you found this Peer Exchange® discussion to be both useful and informative. Thank you.