TAKE AWAY POINTS:
- New targeted therapies such as ibrutinib and idelalisib tend to have both higher efficacy and lower toxicity than standard chemo-immunotherapies for many patients, whether they are high or low risk. More info.
- FCR can sometimes cause difficult to treat secondary blood cancers such as MDS (Myelodysplastic syndromes) and AML (acute myeloid leukemia)
- A significant percentage of patients with poor markers that suggests genomic instability and who are also refractory to other treatments tend to relapse over time with targeted therapies. More info.
- Patients with the same poor prognostic markers treated upfront with new targeted therapies such as ibrutinib or idelalisib do much better.
Hematology in general and CLL specifically are full of jargon and acronyms that can be both overwhelming and daunting. With time and experience, you’ll become familiar with the terminology and acronyms. We will try to explain each medical term the first time it appears in an article, but we will use the true terminology so that you gain comfort and familiarity with the medical terms that you will see in your lab reports and in medical articles. We have provided a glossary and a list of acronyms for your reference.
ESH 2014: Dr. Furman on the Advantages of Upfront Use of New Targeted Therapies
At the ESH (European School of Hematology) International Conference on New Concepts in B Cell Malignancies: From molecular pathogenesis to personalized treatment, Dr. Rick Furman lives up to the ambitious title of the conference held November 14 – November 16, 2014 in beautiful Thessaloniki in northern Greece.
He does so by reminding us of what we already learned about the new targeted therapies from the early research on ibrutinib and idelalisib in frontline settings. He then makes many cogent arguments about the advantages of moving them upfront in therapy. I agree with him that what we patients want is not just a high response rate, but a very, very long progression free survival (PFS). Long-term high quality survival is ultimately what it is all about.
Not everyone agrees with Dr. Furman’s ideas. Except for those of us unlucky enough to have de novo (del) 17p, these therapies are not approved and generally not available for frontline treatment outside of a clinical trial. Guidelines also still recommend chemo-immunotherapy for most treatment-naïve patients.
Dr. Furman would like to see that changed.
Dr. Kipps and others also have concerns about Dr. Furman’s enthusiasm for possible lifelong treatment due to its potential cost and risks.
Here’s the interview. Listen to how Dr. Furman lays out his thinking.
Let us know what you think.
Brian Koffman 3/16/15