Dr. Januario Castro and the other doctors at the University of California, San Diego Moores Cancer Center have pushed for and pioneered non-chemo approaches to treat chronic lymphocytic leukemia (CLL) for many years. At ASH 2015, he discussed his results with the one of the very first and longest-established non- chemo drugs, high-dose methylprednisolone (HDMP), a super high dose of an old and familiar steroid used in combination with the latest antibody, obinutuzumab, or Gazyva.
We have known that the combination of HDMP +R (rituximab) or ofatumumab has produced impressive results, but this study was to assess whether adding the latest antibody would improve the outcomes.
Take Away Points
- There are advantages to avoiding chemotherapy including preventing damage to our bone marrow and our DNA.
- 100% of the treatment-naïve patients and 96% of the relapsed refractory patients responded.
- All of the patients that achieved a complete remission were MRD (Minimal Residual Disease) negative.
- Infusion reactions, so common with obinutuzumab were less severe with this combination. Therapy was generally well tolerated.
HDMP is not for everyone and can be associated with many side effects such as diabetes, serious bone problems, psychiatric issues, and life threatening infections, especially without proper prophylaxis and surveillance.
That said, this research certainly suggests that for some patients, this might be a smart alternative to the approved combination of the old school alkylating chemotherapy agent, chlorambucil used in combination with obinutuzumab.
Also, while there are many exciting non-chemo oral agents approved (ibrutinib, idelalisib, and venetoclax), they don’t work for everyone, so having another option, especially a relatively safe one, is comforting.
Finally, as Dr. Castro points out, this therapy can provide a strong and relatively nontoxic scaffold to which might be added a novel agent to deliver the knock out punch to our CLL.
Here is our interview:
Here is the abstract:
Sometimes it is good to look backward for answers as well as forward.
Brian Koffman, MD 8/30/16