How Ibrutinib and other perhaps other BTK inhibitor work over time in CLL (chronic lymphocytic leukemia)

At ASH 2016 in San Diego, CA, I had the honor of once again interviewing Dr. Wiestner from the NIH (National Institute of Health) about the prototype BTK inhibitor, ibrutinib and how and why it works so well in CLL.

We have known for a while that for its survival and well-being, our cancer is dependent on BCR (B cell receptor) signaling. Blocking BTK (Bruton’s Tyrosine Kinase), blocks that BCR signaling and that blocking usually leads to our cancer’s retreat.

This is a well-understood critical tenet of why ibrutinib works as well as it does, but it is hardly the whole story as we are learning over time.

At the NIH, Dr. Wiestner and his team not only did some of the earliest clinical research on ibrutinib, but also has been doing the bench science on exactly how it works and its impact changes over time.

Please enjoy the interview here: http://cllsociety.org/2017/02/ash-2016-wiestner-ibrutinib-cll/

Stay strong.

We are all in this together.

Brian

http://cllsociety.org

Professor Hallek: The micro-environment in CLL(chronic lymphocytic leukemia)

Preparations are underway for the annual meeting of the American Society of Hematology, or ASH as it’s commonly referred. We’re scheduling interviews with CLL experts, scheduling meeting with current and potential supporters of the CLL Society and preparing our poster for the CLL Poster Session on Monday, December 5^th! So much to do, so little time. .

Today in the Conference Coverage section, we’ve posted an interview with Professor Michael Hallek where he discusses the role of the microenvironment in CLL and why it is an important target. You can view my article and see the interview here. http://cllsociety.org/2016/11/prof-hallek-microenvironment-cll/

Patient & Caregiver Support Meetings

November 21st @ 7:00 PM in Duarte, CA, the City of Hope CLL Support Group will be meeting. See more information here. 

Patient Education Meetings

Saturday, December 17^th - Post-ASH CLL Patient Educational Forum at City of Hope. The CLL Society, in partnership with City of Hope Medical Center and the Leukemia and Lymphoma Society will be hosting the 2^nd annual Post-ASH CLL Educational Forum at City of Hope. Dr. Tanya Siddiqi will be presenting on the latest data on Diagnosis and Frontline Treatment and Dr. Steven Rosen will present on Relapsed Disease and Novel Therapies. You can access the flyer here and pre-registration is requested. We look forward to seeing you there.

Wednesday, December 14^th at 6 PM at the Washington Marriott Georgetown in Washington DC: The Lymphoma Research Foundation will be hosting Updates on Chronic Lymphocytic Leukemia / Small Lymphocytic Lymphoma as part of their Ask the Doctor series. Dr. Chaitra S. Ujjani from Georgetown University Hospital is the featured speaker. You can find out more information and register here. Dinner will be served and there is no charge to attend.

Saturday, December 10^th in Los Angeles, CA. The CLL Society will present at the conclusion of this meeting to assess interest in forming a CLL support group in the west side Los Angeles area. More details in the flyer. Access it here.

In the meantime….

Stay strong.

We are all in this together.

Brian Koffman, MD

11/21/16

http://cllsociety.org

iwCLL 2013: Part 2: Dr. George Calin Explains more about the Critical Role of micro-RNA in CLL

Besides addressing our critical importance of needing to understand the biology of our cancer in order to stop it, in Part Two of my interview from iwCLL 2013, Dr. George Calin of MDACC gives us a brief history lesson on micro-RNA and its relevance for us in unlocking the mysteries of CLL.

He also reinforces and enhances our modern understanding that CLL is not just about our stupid clone or clones, but it is all about how that stupid clone or clones prospers and evolves with the support of many helper or nurse cells that have been tricked into coming to the cancer's aid. Micro-RNA is one way all these cells communicate.

Anti-micro-RNA therapies are already being explored in other cancers. See my immediate prior post.

More than that, he touches on one of my favorite themes: the need to have better predictive tests so that we can individualize therapies. He visualizes a time when, by measuring these tiny "non-coding" pieces of genetic material in the blood, we will be able to better predict what therapies will work for which patients, saving much unnecessary treatments with all the attendant risk of collateral damage.

In the second and final part of the interview, Dr.  Calin expands on the research that he is doing to help all of with CLL.


The abstracts from ASH have just been released and I am going to be very busy reviewing and digesting and commenting on some of the major ones here, but first, in lead up to ASH in December, I have several more very relevant video interviews including hearing from Dr. Kipps, Byrd, Pagel, Kay, and Sharman from the iwCLL meeting in Cologne to post here over the next few weeks.

This is the last  iwCLL interview that is mostly basic science.  The rest are more "clinical" and more immediately relevant.

I will be attending ASH again, and welcome your suggestions for questions and concerns for when I meet with the leading researchers. Drop me an email or comment and I'll try to help. After all, we are all in this together.

iwCLL 2013: Dr. Jan Burger Discusses the Role of the Micro-environment in CLL: Part 1

On the first day of iwCLL 2013 in Koln, Germany, Dr. Jan Burger presented important basic science lab based research on how our CLL cells survive and grow in their protected niches and why it is so difficult to rid us of all the cancer calls, especially those hiding deep in our marrow and nodes.

His strong research along with the pioneering work of Dr. Tom Kipps and others helps us better understand the power of the new small molecules such as ibrutinib and idelalisib, and why we sometimes see the wild rise and slow fall of the absolute lymphocyte counts with treatment, particular with mono-therapy.

Without understanding the factors that influence the vulnerabilities and strengths of the evil clones that we are battling, we would never be enjoying the promise of the emerging targeted therapies. Instead. like the chatter for so many years at past ASH and iwCLL meetings, we would still be studying the best mix of chemo cocktails, admittedly often extremely effective, but coming packaged with all their collateral damage and long and short term risks.

We owe a great debt to all the bench scientist who are finding biological answers with potentially revolutionary clinical implications.

Here is the first of my three part interview with Dr. Burger from MD Anderson, Houston, Texas.

On a person note, today I saw Dr. Steve Forman, my transplant doctor from City of Hope for my twice a year follow-up. He agrees with the plan to taper the IVIG to every eight weeks and we have a plan to reduce my cyclosporin. More on all this later, after I get Dr. Byrd's sign off next week when I am back in Columbus.