Dr. Susan O’Brien from the U. of California at Irvine reviews a study presented at ASCO 2106 about liver inflammation associated with idelalisib in relapsed CLL patients
TAKE AWAY POINTS:
- About 50% of these patients using idelalisib develop liver inflammation (elevated liver enzymes or transaminitis in medical jargon).
- This tends to occur early, is asymptomatic, is reversible and rarely results in having to come off the drug.
Idelalisib is a potent oral inhibitor of PI3K and is similar to ibrutinib in that it blocks B cell signaling and offers impressive response rates
When used frontline in clinical trials, idelalisib has been associated with more significant challenges, both in terms of infections (see this article on the halting of frontline trials and this commentary by Dr. Furman) and also with increased liver inflammation (see this study from Blood) where 79% had some inflammation and 54% had high levels that required intervention such as holding the drug
Dr. O’Brien explains that, based on the data from ASCO and her own experience, in the relapsed setting idelalisib is a safe drug in terms of liver problems, with appropriate monitoring and the infection risk can be mitigated with the recommended ant-microbial prophylaxis.
Here is the link to the abstract from ASCO 2016
Here is the short interview.
Brian Koffman, MD 9/19/16