My friend and fellow
CLLer, Andrew Schorr did a very nice and interesting interview of Dr. Jeff
Sharman at ASH 2012.
Dr. Sharman brings up some
new and provocative insights on how the researchers misstepped when searching
for a specific genetic target in CLL similar to the famously fused Philadelphia
chromosome of CML that Gleevec blocked and in doing so, produced low toxicity,
durable remission. This breakthrough drug, this targeted oral therapy, revolutionized
not just the management of CML, but the whole approach on how we treat or too
often, wish we could treat cancer.
As you have heard many
times, in CLL, it is more complicated. In CLL, it all about “turned on” pathways
than need a brake applied rather than a specific genetic defect. However, as our
knowledge of the activated cellular pathways of the cancerous B cell clone
improves, so does our ability to intervene. That brings us to the new
generation of small molecules including ibrutinib (PCI-32765), idelalisib
(CAL-101 or GS-1101), AVL 292, ABT-199 and others in the pipeline.
He shares his experience of one of of his highly refractory patient finally responding to
one of the new trial medications and another where idelalisib worked when
He cautions us that it is way
too soon to pick winners among the new molecules.
Some of Dr. Sharma’s
tropes you have encountered before from the doctors I spoke with at ASH. It is
good to witness the building consensus.
Some of you may know Dr. Sharman from his well-written, informative blog
on blood cancers and lymphoma. Check it
out if you haven't already. You should also know that he has been a pioneer in small molecule
research and an energetic force in developing resources to get clinical trials
done. He talks about their paramount importance right now. He forecasts the end of the world of
FCR as we know it. He reflects on how well these drugs work for even those with
the worst prognostic markers.
Dr. Sharman asked me if I wanted to share the video. I am, of course,
happy to get the word out however I can.
So enjoy and take heart.
Soon I will be posting my ASH interviews with Drs. Furman, Kipps, Wierda, and
On a personal note, I am home from a medical conference in San Francisco, but just for a few hours before I take off again to lecture in San Diego.
My health insurance has me in a ridiculous Catch 22. I can not get pre-authorized for my roll-over clinical trial at OSU that continues my lifeline of ibrutinib until I sign the informed consent, but I can't sign the consent until I am ready to roll-over into the new trial. All but two insurance companies that cover the myriad of patients from far away places that come to OSU for trials understand the fallacy of such a policy and do not insist on the signed consent, but mine is one of the two that makes it difficult.
That said, I am sure it will all work out (retroactively) with the help of some real kind, persistent, and hard working people at both OSU and Blue Shield. Just one more thing to worry about in the meantime.
On Monday I leave for cold Columbus to finish one trial and begin the new continuation trial. While there, I will be busy with a bone marrow biopsy, another photo shoot and interview. Guess which one I am not anticipating with joy. Hint: there there will be no camera or recorder involved, but there will be needles.
Labels: ASH 2012, Bone marrow biopsy, Clinical trials, Flying, ibrutinib, Idelalisib, interviews, Video