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Talley Traces Developments in Chronic Leukemias

Caroline Seymour
Published: Friday, Aug 03, 2018

Robert L. Talley, MD

Robert L. Talley, MD

Data presented at the 2018 ASCO Annual Meeting indicated both significant remission rates and improved side effect profiles with single agents and combinations in chronic leukemias, said Robert L. Talley, MD.

on A Summer of Progress: Updates from ASCO 2018, Talley, a hematologist/medical oncologist at Centerpoint Medical Center of Sarah Cannon Research Institute, elaborated on the clinical trial findings that are shifting standards of care in chronic leukemias.

OncLive: You presented on chronic leukemias. What were some of the trials you covered?

Talley: The ENESTop protocol looked at long-term follow-up [after discontinuing] all tyrosine kinase inhibitors (TKIs), which in this case is nilotinib. The updated presentation showed continued good response off all TKIs with a low incidence of side effects.

The third trial is the CAPTIVATE study, [which looked at] combination chemotherapy starting with 3 cycles of ibrutinib to try and reduce the tumor burden and decrease chance of tumor lysis syndrome. Then, venetoclax was used with a ramp up. Twelve full cycles of the combination were given to treat patients with primary CLL. The results are quite remarkable with a fairly good side effect profile.

What is the impact of the ENESTop study?

Nilotinib is one of the second-generation TKIs; imatinib (Gleevec) was the first. There are some patients treated with imatinib who don't respond, and there are those who have adverse events. The protocol [is for] second-line treatment, so patients will have already been treated with imatinib. As a second-line agent, it was able to successfully treat patients and get them into deep molecular remissions.

What are the remaining questions with nilotinib? 

We still need to follow the current ENESTop trial because there had been a small number of late relapses. We are unsure what the last day [of possible] relapse is. This is encouraging, but not the final word on ENESTop.

Can you provide background on the data with moxetumomab pasudotox in hairy cell leukemia?

Hairy cell leukemia is a very uncommon condition. The first-name was malignant leukemic reticuloendotheliosis, so you can see why it's now called hairy cell leukemia. It's very descriptive. It's one of the most uncommon chronic leukemias in adults. Until cladribine came along, there was not a very successful treatment option. Splenectomy was almost universally done, but the chemotherapy responses were quite infrequent.
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