A Rapid Shift in Treatment for Chronic Lymphocytic Leukemia - Episode 15
Nicole Lamanna, MD: Any further thoughts that you guys want to summarize or add with regard to the data that we saw here at ASH [the American Society of Hematology 2019 annual meeting] or any key point in CLL [chronic lymphocytic leukemia] that you want to comment on before we close?
Jan Burger, MD, PhD: Well, I can try.
Nicole Lamanna, MD: Yes, we’ll go down the line.
Jan Burger, MD, PhD: It’s exciting to see this wave moving away from chemotherapy-based treatment to the new agents; it’s beneficial to our patients. We’re facing a lot of new issues that we haven’t addressed. We do not know in most cases how to best use them. We still need to define that right now. We talked about what is standard treatment for many patients, which are the BTK [Bruton tyrosine kinase] inhibitors, first, second generation. Venetoclax as a good alternative, as a good salvage option. It’s a transition period. In the United States, we are in a special situation because we have all these agents available, while many other parts of the world not yet. It’s interesting times, and I think it’s time for additional clinical trials to address these questions.
Nicole Lamanna, MD: Javier?
Javier A. Pinilla-Ibarz, MD, PhD: I will join the same conclusions. I think we are in quite exciting times considering that we are starting to have multiple alternatives therapies, being BTK inhibitors and BCL2 [B-cell lymphoma 2 protein] inhibitors, new drugs coming out that we saw today, alternative, reversible BTK inhibitors. I think this is a great time for our patients to make sure that they can have long life expectancies. And definitely start to think about, in the future, how we can address these profound immunodeficiencies that we see in those patients because our patients are going to live longer, so they will be exposed to infections overall and also these secondary cancers. This era is going to bring the next kind of problems of how we’re going to treat those long-term patients and how we’re going to be able to restore the immune system of these patients.
Nicole Lamanna, MD: Rick?
Richard R. Furman, MD: I think as everyone has already mentioned, that this is an incredible era to be taking care of CLL patients, that the number of therapies we have available to us is constantly increasing. We certainly need to understand how best to use these therapies, and a word of caution, if I may, that FDA approvals are certainly not treatment recommendations, and I think it’s important to understand where we’re missing data. What we talked about a lot at this meeting was what we need to do to fill those gaps, like duration of therapy, combination therapy, and so forth. I think in the years to come, we’ll tease out these important questions.
Nicole Lamanna, MD: Farrukh?
Farrukh Awan, MD: I agree. I think all of these developments have been really exciting for our patients. This is the time when we can sit down with the patient and discuss all of these alternatives and look at their likes, and dislikes, and preferences, and comorbidities, and I can then make a decision. I agree, I think FDA approval does not necessarily mean they’re ready for prime-time use. I think for most of us at this point, treatment up front with a single agent BTK inhibitor would still be the correct answer for the vast majority of our patients, and then possibly venetoclax in some way, shape, or form. I think these are exciting times. We’re very excited, and hopefully we can build on all the work that’s been done so far and improve the outcomes for our patients.
Nicole Lamanna, MD: Wow, who would have thought that we all agreed in the end by saying that.
Javier A. Pinilla-Ibarz, MD, PhD: Thanks to you, Nicole, thanks to you. You are the best moderator.
Nicole Lamanna, MD: I think that to summarize for the panel, for all of you, clearly it’s wonderful to have all these agents. I echo my colleagues’ sentiments. Just because we have all these agents doesn’t mean we should use all these agents, and we really need more mature data. We don’t know how to use MRD [minimal residual disease] yet, so these are things that probably shouldn’t be done outside of the context of clinical trials. We need to have these clinical trials, so we can further the development and how to sequence these drugs best, whether it be in combination or sequential therapy, and which patients might benefit from which therapies. Until that happens, we all agreed for once. I want to thank you on behalf of our panel. We hope you found this Peer Exchange discussion to be useful and informative. Thank you, gentlemen, you all behaved.
Transcript Edited for Clarity