ASH 2016: Dr. Seymour on combination therapies for chronic lymphocytic leukemia (CLL)

Combination therapies are the future in CLL. And combinations that include venetoclax are being actively researched.

For good reasons. Venetoclax is a potent drug and a potential closer, wiping the blood and marrow clean of CLL.  Or at least to a level so low that the cancerous clone can't be found.

This week I'm posting on the CLL Society website an interview with Dr. John Seymour from the Peter MacCallum Cancer Centre in Melbourne, Australia when we talked at ASH 2016 about combination therapy with venetoclax. You can view my summary, watch the interview or read the transcript at http://cllsociety.org/20…/…/ash-2016-venetoclax-combination/.

For those of you who didn't catch this last week, check out the new 2 minute video I posted about helping to fulfill the mission of the CLL Society. You can view it at http://cllsociety.org/donate-to-cll-society/. We are so thankful to those of you who provided feedback and support us.

Stay strong

Brian

PS: I will be posting a personal update here very soon.

ASH 2016: Dr. Matt Davids of the combination of TGR-1202 and ibrutinib for relapsed refractory CLL (chronic lymphocytic leukemia)

This week, on the CLL Society website we are sharing a video interview with Dr. Matthew Davids from  ASH 2016 where we discuss a clinical trial that combines two targeted therapies for treating relapsed/refractory CLL, ibrutinib and TGR-1202. You can read the summary and watch the video or read the transcript here . TOMORROW, we'll be publishing the first 2017 issue of The CLL Tribune and marking the 2 year anniversary since our website went live! Watch for it! Two years. WOW! CLL Patient Support Group Meetings This Week Monday, April 3rd at 6 PM in Indianapolis - the CLL and Indolent Blood Cancers Support Group will be meeting. More information here. Tuesday, April 4th at 7 PM in Tucker, GA - the Tucker Family Support Group, sponsored by the Leukemia and Lymphoma Society will be meeting.  More information here.     NEW CLL Patient Support Group Meetings Coming Up Saturday, April 15th at 3 PM in Vienna, VA -  the Washington DC-Area CLL Support Group, sponsored by the CLL Society will be meeting for the first time. More information here. Saturday, April 22nd at 1 PM in the Boston area - the Boston CLL Support Group, sponsored by the CLL Society will be meeting for the first time. More information here.  Sunday, April 23rd at 4 PM in San Francisco -  the San Francisco CLL Support Group, sponsored by the CLL Society will be meeting for the first time. More information here.  ALSO -  We are actively forming CLL-specific support group in a number of cities around the country. To see if your city is one of them, go to our home page  and click on the interest survey for your city. JUST ADDED - Rochester, NY; Milwaukee, WI; Atlanta, GA; Salt Lake City, UT; Huntsville, AL. Not listed, but interested in starting one? Email us at support@cllsociety.org. Thanks! Upcoming Patient Education Meetings Saturday, April 1st from 7:30 AM to 3:00 PM in Atlanta, GA: The Lymphoma Research Foundation will be hosting Lymphoma Workshop: Understanding Lymphoma Basics and Current Treatment Options which will include disease-specific breakout sessions. There is no cost to attend, but registration is required. Find out more information here. ALSO Rick Conner, a CLL patient in the Atlanta area will be manning the CLL Society table and collecting names of those who might be interested in a CLL-specific patient support group. Stop by and say Hello! Thursday, April 6th from 6:00 PM to 8:30 PM in Boston, MA: The Lymphoma Research Foundation will be hosting Ask the Doctor: Updates on CLL/SLL. There is no cost to attend, but registration is required. Dinner will be provided for registered attendees. Find out more information here.  Thursday, April 20th from 6:00 PM to 8:30 PM in Cherry Hill, NJ: Anthony Mato, MD, MSCE from the Abramson Cancer Center in Philadelphia will be chairing the patient educational forum, CLL in 2017: State of the Art Management from a Patient's Perspective with his team. Brian Koffman, MD from the CLL Society will also be speaking. There is no cost to attend, but registration is required. Attendance is limited and registration will be closed when attendance limits are reached. Dinner will be provided for registered attendees. Find out more information here.  Monday, April 24th in Columbus, OH and streaming live: Ask the Expert: Nutrition & Chronic Lymphocytic Leukemia will be held at The James at Ohio State University. This event is free, but pre-registration is required. Visit https://nutritionandcll.eventbrite.com  to register or for more information, please call JamesCare for Life at 614-293-6428. Find out more information here.  In the meantime.... Stay strong. We are all in this together. Brian Koffman, MD March 28, 2017 http://cllsociety.org

Combination Therapy in CLL

This week, I am sharing a video of Dr. Jennifer Brown from Dana Farber Cancer Institute where she discusses the possible next steps in combination treatment strategies for chronic lymphocytic leukemia (CLL). You can read my summary and watch the interview here.

This is the future. And the direction that we need to continue to research

NEXT WEEK, we'll be publishing the first 2017 issue of The CLL Tribune and marking the 2 year anniversary since our website went live! Stay tuned!

Stay strong.

We are all in this together.

Brian

http://cllsociety.org

ASCO 2014: Dr. Susan O'Brien Speculates on Combinations with Ibrutinib to Get a Complete Remission in CLL (chronic lymphocytic leukemia)

In the second part of my audio interview, Dr. O'Brien of MD Anderson today and next year at UCI gives her opinion on one of my favorite topics, what combination of novel agents (and I am only  talking non chemo combos) might and might not do when added to ibrutinib as the backbone of a therapy. Can we get deeper responses? Can we get to cure?

The same speculations, and at this time it is all speculation, could be made for combos with idelalisib or ABT-199 or any of the novel agents in trial. The only way to find out is with research.

Here is just one example of one such interesting trial that was just posted today.

Dr. Susan O'Brien starts by rightly asks us to look at the data separately for the treatment naive group and the relapsed refractory gang.

Those lucky folks who got ibrutinib frontline may be on cruise control for a long long time and if so, why mess with a good thing by adding in another medication

Next please listen carefully as Dr. O'Brien does a good job of reminding us of what exactly we know from trials and what we think we know.  For example we know that obinutuzumab (Gazya) is a much better monoclonal antibody (mAb) than rituximab when used with chlorambucil or Leukeran to tray CLL.  What we think but don't really know is whether it is a better antibody when used in other combos for CLL. As I have reviewed in past posts about glyco-engineeered mAb such as Gazya there is good reason to expect that it is a better killer of B cells, but that has yet to proven.

I also agree with her that much of the benefit from adding a mAB to ibrutinib might be cosmetic, getting us a quicker response by blunting the rise in the absolute lymphocyte count seen early in treatment. When you look at the data further down the line, there is little difference in the already strong outcomes with or without an anti- CD 20 antibody aboard.

This interview will make more sense if you catch the first part of our conversation here.

Finally, another plea for your tolerance. The audio quality is terrible: full of hisses and pops. And don't worry, you have not gone through a time warp. I do repeat a few seconds on the interview just passed the seven minute mark. It's a good thing I don't make a living as a sound engineer.

I hope the quality of the information will allow you to forgive the lousy recording technique.

As I have said before the near future will be full not just of better recordings (made certain by my plan to engage recording professionals at the big congresses), but also I will be posting more focused CLL education.

Please stay tuned over the next few days.

I will need your help with an upcoming survey and will be posting some new kinds of material that I hope you will enjoy and learn from.

Here is Dr. O'Brien


A very busy and productive ASH 2014 is just a few days away. And trust me,  I am bringing a video professional for all my scheduled interviews.

Dr. Byrd: "We are at an incredibly exciting time for patients and their families with CLL (chronic lymphocytic leukemia)" Let's all bake a cake of cure.

Cake of Cure

OK team, we have taken the first giant step in this moon shot. We've safely landed in a new world of disease control with no chemo. Now get us home.

The real work is just beginning.

We need potent combos of these new wonder drugs to help us stay in the land of remission forever, get off the daily meds, and maybe, just maybe find our decades from now that we have been cured.

We need more trials, trials that use NO chemotherapy. Trials that use drugs from different pharmaceutical companies. Abbvie links with Infinity Pharmacyclics is already working with TG Therapeutics in a clinical trial.We need more of these alliances that break down commercial barriers for the benefit of the patients.

We need brave patients to volunteer. While all of this sound so positive, let's not forget that when Gilead ran a sensible and necessary trial combining its Syk inhibitor, GS-9973 and its better known PI3k inhibitor, idelalisib or Zydelig (click here for the abstract), they concluded: "Despite promising activity in CLL, the combination of GS-9973 and Idelalisib resulted in an unexpectedly high rate of pneumonitis and resulted in stopping dosing of the combination These data need to be considered when designing future investigations combining inhibitors of B cell receptor signaling."

So we can't take anything for granted. These trials need to be carefully designed and monitored. But they are our best path to a cure.

It demands patients and providers and industry and the FDA all fighting together to "bake a cake of cure" for  CLL.

I like it.

Please enjoy this upbeat and realistic one minute video of my doctor, Dr. John Byrd out of OSU.



More soon on ROR1 including an exciting new trial,  and also on challenging paper on new mathematical modeling of ibrutinib resistance.

Good times indeed. Let's have our cake (vegan of course) and eat it.

ASH 2012: Dr. Tom Kipps on Genetics, Epigenetics, and Targeted Therapy

In the third of a four part interview with my CLL doctor, Dr. Tom Kipps out of UCSD, we hear him present a vision of the future of "personalized" cancer therapy in general and CLL in particular.

But he also tells us what targeted therapies are available right now in clinical trials near you.

In CLL, it is less about the genetic code and more about the epigenetics. This crucial and relatively recent understanding has been critical in advancing therapies because the pinpoint DNA damage seen in CML such as the telltale fused Philadelphia chromosome are frustratingly less of a glaring target in CLL. However, when the researchers instead started identifying the overly activated pathways in our clonal B cells, the progress sped up in decoding and quickly thereafter, controlling our disease. Dr. Kipps walks you through the difference in these approaches.

Dr. Sharman talks about this insight in one of my prior post, and here Dr. Kipps makes it all easy to understand. He also explains combination therapies, the importance of the new and old generations mAbs (monoclonal antibodies) including 1st generation rituximab, 2nd generation ofatuzamab, and the promise of the powerful 3rd generation GA-101 or another mouthful of a name, obinutuzumab, all directed at CD20, re-use of some drugs already approved for other cancers, and CAR-T therapy

Eleven minuted well spent. Dr. Kipps breaks it all down into bite size pieces.

Learn and enjoy:



Part Four with Dr. Kipps will be coming soon and I still have Drs. Wiestner and Furman in the video vault. ASH 2012 was an amazing meeting, jam-packed with hope and good news for those of us with CLL.

Personal notes:

I am still waiting for my final bone marrow biopsy report from OSU done Feb 5, 2013. FISH and cytogenetics should be back by now, and I hate the suspense.

Back home from studying hematology for hematologists at the 17th Annual International Congress on Hematologic Malignancies – Focus on Leukemias, Lymphomas, and Myeloma in Manhattan and the MDACC hematology board reviews, so I can be more fluent in speaking about the buzz around small molecules such as ibrutinib, ABT-199 and idelalisib in treating other B-cell lymphomas in particular and blood cancers in general.

I will also return to posting more on the personal and human aspects of dealing with an incurable cancer, but for right now, my priority is to get all the remaining ASH 2012 videos online over the next few weeks.

Next weekend, I am off to Washington DC to lecture to the National Sleep Foundation on "The Sleepy Patient". Then I am home for several weeks in a row. Yeah!

In the spring and fall, I will be flying all over the place again teaching other doctors about anemia (MDS or myelodysplastic syndrome that can be a challenging late complication of CLL and some of the chemotherapy used to treat it), gout and thyroid disease. I will be posting my ASH 2012 interviews with Dr. Steensma on MDS here soon.

For any health care providers reading this blog, and to anyone else interested, for another few weeks until March 6, 2013, at Primary Issues, an online medical journal, you can receive ACCME accredited CME on the recognition and early lab testing of CLL or just learn from my article and interviews with Drs. Wiestner and Kipps done at ASH 2011. That San Diego meeting 14 months ago is where I made the fateful decision to enroll in the clinical trial NCT01217749 at OSU that has served me so well.

My love is teaching and my special love is teaching hematology and making sure that the patients and their providers are teamed together to offer the best possible care for each individual case. That's what I want to do more and more.

I am hoping to find some funding do more of these interviews and news coverage for patients and healthcare providers alike, to expand beyond the big ASH meeting to ASCO and IWCLL and more. Next up will be ASCO at the end of May, where I bet there will be important updates on ibrutinib, idelalisib, ABT-199, obinutuzumab and others.