In the second part of my audio interview, Dr. O’Brien of MD Anderson today and at UCI in 2015 gives her opinion on one of my favorite topics, what novel agents (and I am only talking non-chemo combos) might or might not do when creating ibrutinib combinations to treat chronic lymphocytic leukemia (CLL). Can we get deeper responses? Can we get to cure? The same speculations, and at this time it is all speculation, could be made for combos with idelalisib or ABT-199 or any of the novel agents in trial. The only way to find out is with research.
Dr. Susan O’Brien starts by rightly asks us to look at the data separately for the treatment-naive group and for the relapsed refractory gang. Those lucky folks who got ibrutinib frontline may be on cruise control for a long, long time and if so, why mess with a good thing by adding in another medication.
Next please listen carefully as Dr. O’Brien does a good job of reminding us of what exactly we know from trials and what we think we know. For example, we know that obinutuzumab (Gazya) is a much better monoclonal antibody (mAb) than rituximab when used with chlorambucil or Leukeran to treat CLL. What we think but don’t really know is whether it is a better antibody when used in other combos for CLL. As I have reviewed in past posts about glyco-engineeered mAb such as Gazya there is good reason to expect that it is a better killer of B cells, but that has yet to be proven.
I also agree with her that much of the benefit from adding a mAb to ibrutinib might be cosmetic, getting us a quicker response by blunting the rise in the absolute lymphocyte count seen early in treatment. When you look at the data further down the line, there is little difference in the already strong outcomes with or without an anti- CD 20 antibody aboard.
This interview will make more sense if you catch the first part of our conversation here.
Finally, a plea for your tolerance. The audio quality is terrible: full of hisses and pops. And don’t worry, you have not gone through a time warp. I do repeat a few seconds on the interview just past the seven minute mark. It’s a good thing I don’t make a living as a sound engineer.
I hope the quality of the information will allow you to forgive the lousy recording technique.
Here is Dr. O’Brien
Dr. Brian Koffman 12/2/2014