Thursday, January 9, 2014

iwCLL 2013: Prof Hallek Discusses a Focused Role of Chemo-Immunotherapy

In this brief second part of a three part interview from iwCLL 2013, Professor Hallek precisely defines the populations that do well with chemo-immunotherapy.

It is important to keep in mind that it was only with the addition of rituximab, an anti- CD20 monoclonal antibody,  to a chemo backbone of FC, comprising together the "gold standard" therapy of FRC, that a survival advantage was first shown. Prior to the German study presented at ASH only a few years ago that proved FCR prolonged lives, no therapy had been shown to help us live a day longer.

At iwCLL 2013, we learn some very important new wrinkles on exactly who it is that benefits from FRC.

There should be no debate that the role of CIT (chemo-immonotherapy such as FCR or Bendamustine -Rituximab or BR) is shrinking. Who benefits is a shrinking pool of CLL patients with very specific demographics and FISH findings and the good news that they are mutated. This argues strongly that we should never consider FCR without first knowing our mutation status and our FISH results.

The debate is whether there is any role at all for CIT even in that select population.

The question how intense the CIT protocol should be or what is best approach may soon be moot with all the new kinase inhibitors changing everything, but at ASH 2013 a few months later we did learn that FCR has deeper longer remissions than BR but at the price of more toxicities, so the answer is as always in CLL: It depends on the patient. More on this ASH abstract later

Listen to Professor Hallek discuss who should consider CIT and who should not.

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