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New drugs make treatment of CLL like a chronic disease

Thursday, March 10, 2016

John Allan, M.D.John Allan, M.D. Although it remains an incurable disease, patients diagnosed with chronic lymphocytic leukemia (CLL) who are treated with new targeted agents may have a normal life span, researchers suggested at the first Cancer Survivorship Symposium.

“The results from our study suggest improved overall survival for patients treated with ibrutinib (Imbruvica) compared with standard combination chemotherapy used in CLL,” said John Allan, M.D., Assistant Attending Physician and Assistant Professor of Medicine at Weill Cornell Medicine.

“Overall survival results suggest that ibrutinib may fundamentally change the natural history of CLL, such that treated patients may approach the life expectancy of the general population,” he told OT at his poster presentation.

In his presentation, Allan illustrated that treatment with ibrutinib in patients with newly diagnosed CLL showed better survival rates than treatment with former standard of care, chlorambucil-based chemotherapy. He and his colleagues performed a Bayesian Network Meta-Analysis conducted in line with the National Institute for Health and Care Excellence. They found that a 72-year-old person from the general population had a three-year overall survival of about 92 percent; patients treated with ibrutinib for initial therapy for CLL achieved a three-year survival of 96.6 percent at two years in one study and 98 percent survival at two years in a second study.

With treatment with ibrutinib, Allan noted, doctors were able to demonstrate humoral immune reconstitution in patients with CLL, recovery of normal B-cells, and partial reconstitution of humoral immune function.“The decreased infection rate over time observed with ibrutinib treatment contrasts with the increased rate of severe and persistent infections associated with traditional combination chemoimmunotherapy, which suggests that ibrutinib may provide a valuable option to control CLL,” Allan said. “Overall, single agent ibrutinib treatment appears to demonstrate a favorable safety profile while improving hematologic and immune function.”

In reviewing the medical iterative, the researchers reported that long-term follow-up of ibrutinib indicated that treatment led to diminished toxicities over time, including Grade 2/Grade 3 cytopenias and infections. Dose reductions of ibrutinib occurred mainly in the first year of treatment, and toxicity leading to ibrutinib discontinuation diminished with continued treatment.

“In contrast [with other treatments], single agent ibrutinib led to manageable toxicities that were mainly mild to moderate in severity with low rates of dose reduction and low rates of discontinuations due to adverse events,” Allan said.

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Allan said that changing CLL treatment to a chronic disease, requiring daily oral medication, may create other treatment concerns.

“Prolonged treatment and management of patients with CLL using novel oral agents such as ibrutinib require a new focus on adherence and patient management to support successful long-term outcomes,” he said. “The advent of new targeted oral agents in CLL may suggest that we are on the cusp of moving away from a palliative chemotherapy-based care model where efficacy is frequently forfeited for acceptable tolerability.”

This is an excerpt of an article that appeared in Oncology Times. Read the full story here.