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In my final post from the last days of ASH 2013, my doctor, Dr. John Byrd out of Ohio State (OSU) discusses the durability of the positive results with ibrutinib and the latest results with obinutuzumab in the treatment of chronic lymphocytic leukemia. Here is the referenced ibrutinib trial, The first part of my interview with Dr. Byrd can be found here and part two here. These are worth reviewing as we covered many of the novel therapies beyond the usual headline grabbers of ibrutinib and obinutuzumab that are the focus of this last segment of the interview.
Dr. Byrd reminds us that it is the usual suspects, mostly those of us CLL patients who have been heavily pretreated and/or are 17p deleted, that are the unlucky ones who do relapse on ibrutinib. Later studies suggest the real culprit might be a complex karyotype. See more.
What is the happy surprise is that the side effects seem to get less common the longer we take ibrutinib and there is a hint (see this NIH research by Dr. Farooqui whom I subsequently interviewed at ASCO 2014), that our immunity improves. Certainly the number of infections diminishes over time.
Dr. Byrd also answers my questions on the exciting monoclonal antibody obinutuzumab (Gazyva) and the new study results presented at ASH.
There are many reasons to be excited about this antibody. Despite the fact that some might argue that the trial was rigged by choosing the wimpy chlorambucil as its sparring partner, obinutuzumab is the first therapy when used with chlorambucil to show a clear survival advantage in the difficult to treat mostly elderly patents who have other medical problems (co-morbidities) such as kidney disease that may take many therapies off the table. This trial is offering hope where there is a pressing need.
We get into some of the details of how the drug is different from other antibodies. Dr. Byrd discusses how its engineering was specifically directed to make it different and probably better than rituximab. We also discuss its potentially nasty and quick infusion reaction and why that may not be such a bad thing.
Enjoy Dr. Byrd.
Brian Koffman 7/11/14 Revised 3/17/15