In the first brief section of my video interview from ASCO 2014, Dr. Tom Kipps, my personal doctor at UCSD, mentions the buzz about ibrutinib (IMBRUVICA) at the meeting and then moves on to discuss obinutuzumab (GAZYVA), the new and exciting monoclonal antibody (mAb). He adds to what we learned from Dr. Byrd from ASH 2013 and shares his subtly different take on how this powerful new addition to our CLL arsenal works.
My hunch is that it will prove to be much bigger step forward from rituximab (R) than was ofatumumab (ARZERRA). That much anticipated next generation CD 20 mAb has disappointingly made at best some small incremental improvement for us CLL patients compared to the giant leap that we witnessed just a few years ago when the mother of all CD 20 antibodies, R was added to FC to give us the present “gold standard” of FCR. Ofatumumab does offer a possible helpful option for those of us who cannot tolerate R.
Obinutuzumab is the first antibody that showed a clear survival advantage over rituximab albeit in combination with chlorambucil and may be proving to be a better antibody. .
At ASCO 2014, we learned more. This abstract shows us that as a single agent in untreated patients, obinutuzumab had impressive response rates and even some complete remissions. This almost never happens with the other older CD 20 antibodies. I am pretty excited about all these results.
We already know that adding an antibody to almost any chemo agent makes that chemotherapy work better and explains why chemo-immunotherapy has become the backbone of the present treatment protocols in CLL/SLL and other lymphomas.
What we don’t know yet is how this concept of adding a mAb will evolve in the coming era of oral therapies with small molecules such as ibrutinib and idelalisib and later on ABT-199.
Here is the first part of my interview with Dr. Kipps.
Listen to the lovely way that he describes how the different type antibodies works.
Brian Koffman 7/7/14