ASCO 2013: A Call for New Ways of Thinking
But boy is there a ton of new research to share.
While ibrutinib and idelalisib have kicked open the door to explore new less toxic pathways to control not just CLL, not other B cell cancer, they did not close the door behind them.
Novel pathway inhibitors beyond PI3K and BTK and BCL-2 are being explored and being explored in novel ways with more open access.
New and potentially potent BTK and PI3K inhibitors are in trials now.
Combinations are being considered.
Dr. Wiestner said these new drugs offer us the opportunity to think in new ways.
Hence my disappointment when I hear speakers rightly celebrate the lack of bone marrow suppression with these new targeted therapies, but then got all excited about how that allows them to pile on the old school bone marrow damaging chemotherapy. Maybe we do need to go in that direction, but can't we try to leverage the low toxicity of these drugs but adding other low toxicity agents to them, offering patients like us gentler and less risky control of our disease.
I like the idea of adding together more than one TKI or adding a monoclonal antibody or an IMID.
In my book, adding in bendamustine or fludarabine or chlorambucil or their ilk should make a significant difference in outcomes to justify the additional downside risk.
I understand the temptation to revert to tried and true paths. And it might turn out to be the best call. Medicine must be both conservative and progressive.
But we have a sea change, a paradigm shift, happening in CLL. Let's try to keep innovating and exploring using the kind of thinking that got us the breakthroughs with ibrutinib and idelalisb and ABT-199.
That is the next stage of research that has me excited.
That is the future that I want for all of us.