tag:blogger.com,1999:blog-2741672436160438708.post1564512827272461134..comments2024-03-26T12:50:32.070-07:00Comments on Learning from and about cancer (chronic lymphocytic leukemia or CLL) by Dr. Brian Koffman: ASCO 2014: Dr. O'Brien Discusses Improved Trial Designs, CT Scans and the role of Chemo-immunotherapy In Frontline Therapy in CLL (chronic lymphocytic leukemia)Brian Koffmanhttp://www.blogger.com/profile/13250684684103918493noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-2741672436160438708.post-84314663285118155482014-12-14T13:38:14.075-08:002014-12-14T13:38:14.075-08:00Great post. Quick question on the survey: I've...Great post. Quick question on the survey: I've tried to take it several times, but keep getting stumped on the inability to answer questions differently than I have to do. For example: forced choice between doctor blogs and patient blogs. You are both, and one of my most important sources, but exactly BECAUSE you are both. How do I choose? Same with Andrew Schorr's blog and broadcasts. It's the combination of being a patient and/or journalist/doctor that makes the both of you so trustworthy. And ranking: is 1 considered most or least important? Surveys have a tendency to differ when asked to rank. Thanks for all your work!<br />AMAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2741672436160438708.post-45688068361087609822014-12-14T11:40:04.148-08:002014-12-14T11:40:04.148-08:00First "Anonymous" here again — In my sit...First "Anonymous" here again — In my situation, I've been told to seriously consider FCR, BUT I was also offered the ACP-196 trial. So I'm also curious to know the answer to the second "Anonymous's" question — "What prevents someone from starting with the newer agents first and if resistance or disease progression occurs go on to FCR rather than the other way around?"Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2741672436160438708.post-40868377559061189462014-12-14T06:47:39.492-08:002014-12-14T06:47:39.492-08:00Hi Brian,
With all due respect to one as learned a...Hi Brian,<br />With all due respect to one as learned as Dr. O'brien the perspective from one who is the patient and taking the risk that he/she is not going to be one of the 40% is fundamentally different. If the rationale for FCR is heavily weighted because of the "bright" expression of CD20 in 12 trisomy patients then why would a patient not be advised to gamble on one of the newest CD20 targeted mAbs like Obinutuzumab? Trisomy 12 is a marker that is fairly heterogeneous so I would want to know more about the volume quality of aberration before accepting FCR. This example to my thinking is begging for more data that might be obtained from NGS (Next Gen Sequencing).<br /><br />How about a comparison of therapy paths for a Trisomy 12 patient in which an HSCT (Hematopoietic Stem Cell Transplant) is weighed against FCR. If the patient has a great matched donor the odds are roughly 60% cure vs 40% checking out of the "Hotel Life". Prospects of GVHD (Graft vs Host Disease) takes the clean edge off the percentages but if you are a gambler why not go for the brass ring?<br /><br />Given the prospect of therapeutic advances, does the buy-yourself-time with less toxic therapies in the face of probable relapse look so bad? Ya pays yer nickel an ya takes yer chances my friend.<br /><br />WWW<br /> Anonymoushttps://www.blogger.com/profile/08783029423801860411noreply@blogger.comtag:blogger.com,1999:blog-2741672436160438708.post-7531298750034505852014-12-13T17:40:57.924-08:002014-12-13T17:40:57.924-08:00Highly informative as usual. My question is what ...Highly informative as usual. My question is what prevents someone from starting with the newer agents first and if resistance or disease progression occurs go on to FCR rather than the other way around. FCR may change the cytogenetics and leave a more aggressive CLL and may predispose to a second malignancy. I have not seen this question addressed. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2741672436160438708.post-80153606271970654592014-12-13T10:07:20.947-08:002014-12-13T10:07:20.947-08:00Thanks, Brian. Andrew Schorr? This is why FCR sc...Thanks, Brian. Andrew Schorr? This is why FCR scares me. Sure, a good chance at a nice long remission, and worth considering for sure, but at what cost? Might I be setting myself up for another blood cancer (maybe even MDS/AML)??? Guess I was hoping you'd say, "No, don't do it because you don't have the trisomy 12 deletion!" LOL! :) Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2741672436160438708.post-50030339795755674912014-12-13T09:26:43.879-08:002014-12-13T09:26:43.879-08:00The best data is on the combo I described, but odd...The best data is on the combo I described, but odds are good that you will get a long remission from FCR with your profile. I have a friend who is 14 years out and still MRD negative, but he has a second blood cancer. Worth considering: 6 months and done.Brian Koffmanhttps://www.blogger.com/profile/13250684684103918493noreply@blogger.comtag:blogger.com,1999:blog-2741672436160438708.post-88150892194471168942014-12-13T06:12:21.010-08:002014-12-13T06:12:21.010-08:00Hi Brian. Thanks for another great post. Quick q...Hi Brian. Thanks for another great post. Quick question and just want to confirm: You said, "Consider FCR frontline if you are young, healthy, mutated, and trisomy 12. But only under those circumstances." I'm all of those, except I'm 97% 13q (no trisomy 12), and at the point of deciding what front-line treatment to use. Have to admit FCR scares me, but don't want to throw it out without first carefully considering it might be the best front-line treatment for me. In your opinion, though, I should not do FCR because I am not trisomy 12, correct? Anonymousnoreply@blogger.com