Thursday, July 17, 2014

ASCO 2014: Dr. Kipps Discusses Targeted Therapy and Obinutuzumab in the Treatment of CLL (chronic lymphocytic leukemia)

In the first brief section of my video interview from ASCO 2014, Dr. Tom Kipps, my personal doctor at UCSD, and mentions the buzz about ibrutinib (IMBRUVICA) at the meeting and then moves on to discuss obinutuzumab (GAZYVA) the new and exciting monoclonal antibody (mAb). He adds to what we learned from Dr. Byrd in this prior post from ASH 2013 and shares his subtly different take on how this powerful new addition to our CLL arsenal works.

My hunch is that it will prove to be much bigger step forward from rituximab (R) than was ofatumumab  (ARZERRA). That much anticipated next generation CD 20 mAb has disappointingly made at best some small incremental improvement for us CLL patients compared to the giant leap that we witnessed just a few years ago when the mother of all CD 20 antibodies, R was added to FC to give us the present "gold standard" of FCR. Ofatumumab does offer a possible helpful option for those of us who can not tolerate R.

Obinutuzumab is clearly proving to be a better antibody. As I covered in this more detailed post and interview from ASH 2013 with Dr. Brown, GAZYA is the first antibody that showed a clear survival advantage over rituximab albeit in combination with chlorambucil.

At ASCO 2014, we learned more. This abstract shows us that as a single agent in untreated patients, obinutuzumab had impressive response rates and even some complete remissions. This almost never happens with the other older CD 20 antibodies. I am pretty excited about all these results.

We already know that adding an antibody to almost any chemo agent makes that chemotherapy work better and explains why chemo-immunotherapy has become the backbone of the present treatment protocols in CLL/SLL and other lymphomas.

What we don't know yet is how this concept of adding a mAb will evolve in the coming era of oral therapies with small molecules such as ibrutinib and idelalisib and later on ABT-199. More on this in future posts.

Here is the first part of my interview with Dr. Kipps.

Listen to the lovely way that he describes how the different type antibodies works.

More to come soon on ROR-1.

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Anonymous Anonymous said...

Awesome stuff! Can't wait to hear about the ROR-1 antibody. I wonder if it will be the kind that will paint the cell with candy for NK cells (I believe that is type 1), or the kind that with direct disturb the cell biology to induce death (I believe type 2). As far as I can tell, type 1 isn't necessarily inferior to type 2?

July 17, 2014 at 7:10 AM  
Anonymous Anonymous said...

I finished Gazyva monotherapy in May as frontline treatment. I am very happy with the results, all blood counts normal (except for low lymphocytes levels, of course) and all lymphadenopathy is gone. Now I will wait to see how long the remission holds.

July 17, 2014 at 9:02 AM  
Blogger Brian Koffman said...

To the Gazyva monotherapy patient, please email at LLS is looking for a Gazyva patient.

July 17, 2014 at 10:45 PM  

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