Sunday, November 30, 2014

ASCO 2014: Dr. Susan O'Brien Reviews the 3 years follow-up Data on Ibrutinib in CLL (chronic lymphocytic leukemia)

If you can handle more hisses and pops on an audio recording, you will get to hear some pretty exciting news from Dr. Susan O' Brien who incidentally is leaving MD Anderson after many years of important CLL related research and compassionate patient care to head up a cancer research team  and consult on CLL patients in my backyard at the University of California at Irvine (UCI) starting Jan. 1, 2015

During the interview, Dr. O'Brien shares the three year follow-up data on single agent ibrutinib in relapsed and refractory patients and in the elderly.

In her important ASCO 2014 abstract, published 6 months ago, the data is astonishingly good for those lucky enough to get ibrutinib frontline, the over 65 crowd, a strong argument in favor of moving it and other drugs such as idelalisib or ABT-199 upfront.  In this trial, in the treatment naive arm, there was one early progression with Richter's that was probably there before the trial even began, and the rest of the cohort remains in the happy land of PFS also known as progression free survival.

The data is still very good for the difficult to treat relapsed and refractory group, but the curve is not flat. Relapses happen. This is especial true for those of us like me with the dreaded 17p deletion, where half the patients have started to progress after a little more than two years. While this is clearly much better than anything else out there in this most challenging population, ibrutinib has not hit a home run for this group as it might have for the treatment naive patients.

Despite significant recent progress, effective long term therapies for relapsed 17p deletion still remains one of the more pressing unmet needs in the world of CLL.

Dr. O'Brien discusses what these relapses look like, and mentions a strategy that I would strongly consider, namely that even at the time of relapse, one stay on ibrutinib until a new therapy is begun, as the BTK inhibitor, even it is no longer irreversibly binding, it is still partially braking the disease progression.

Let's listen to Dr. O'Brien.

Again sorry for the audio noise. Once these final ASCO interviews are posted, I promise I will not only be notching up the quality of what you see and hear about CLL here and elsewhere, but with the help of many others, will be expanding into whole new realms of education and support to meet the unmet needs of our community. Stay tuned.

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Anonymous Anonymous said...

My husband is currently on the ACP 196 trial-he started in Sept this year. He is doing well but he had developed the 17p deletion without having any prior treatments. I am not sure if this puts him in a better bracket or a worse one. There is much discussion around relapsed-refractory with 17p or simply treatment naïve-but I am not sure if ay of the treatment naïve were 17p. He is having ACP 196 as his frontline-I am curious to know what bearing this will have on his overall survival.

November 30, 2014 at 3:16 PM  
Blogger Brian Koffman said...

With ibrutinib the few treatment naive patients with 17p deletion have done very well, better than those who relapsed with 17p. De novo 17p seems to be a different disease and is sometimes much slower moving. Complex karyotype might be the bigger problem for the new TKIs. ACP 196 is too new to comment, but it looks very good so far.

November 30, 2014 at 3:49 PM  
Blogger Unknown said...

Hi Brian,

Great news for the newly diagnosed who might be able to avoid Chemotherapy.

What would the R&R crowd look like if they had gotten Ibrutinib instead of chemo/mAb therapies from the git-go? With frontline TKI patients, can we test how Chemo/mAb therapies might be damaging patients creating more aggressive CLL?

If the data is showing the rate of infections in the R&R Ibrutinib group, who do not relapse, are improving with time it is reversed for me. In my case (Phase Ib Trial with Ibrutinib monotherapy - R&R patient) I have an increase in infections but well within a healthy person's expectations. I was free of infections for 6 years, suffering only one head cold and LOSING a foot fungus of 44 years and a herpes simplex outbreak of a 25 year duration. Once on Ibru I experienced 2 colds in 2011-12, 2 colds in 2012-13, bronchitis in 2013-14 return of fungus for 3 months & now with a flu. Immunoglobulins are unchanged from pre Ibru testing.

My immunity is demonstrably less while on Ibrutinib. This demonstrates the extremes of immune function that need to be medically explored.


November 30, 2014 at 7:22 PM  
Anonymous Michele Santobello said...

Thanks Brian-that's good to know.

December 2, 2014 at 1:52 PM  

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