Ibrutinib’s Approval History and Its Use as Frontline Therapy for CLL
To build on the ASH 2015 interview with Dr. Richard Furman on MRD negativity in CLL, we’d like to highlight an article that was published in Oncology Times in mid-July. The target audience was hematologist/oncologists and was based on a session from the Great Debates and Updates in Hematologic Malignancies meeting, but it’s quite readable and points out how the role of MRD negativity in CLL is evolving. The question posed was “In this era of novel agents, is a complete response (CR) and minimal residual disease (MRD) negativity still required for chronic lymphocytic leukemia (CLL) patients? “
Setting the stage for the Point-Counterpoint debate, “Is MRD Negativity Necessary for CLL Patients?,” Matthew Davids, MD from Harvard Medical School took the stance “Yes, But CLL Therapy Differs By Age” and Richard Furman, MD from Weill-Cornell countered with “No, A Partial Response Is Preferable.”
According to Davids, the precedent for cure is first attaining MRD negativity. The question is nuanced, and the answer is ‘It depends,’” Davids said. “An 80-year-old with CLL has a life expectancy of 5-10 years. The younger set at age 40 or 50 may be on therapy for 40 years. The answer is different for these two populations.”
Dr. Furman counters that ‘the most important part of the debate surrounds survival. Progression-free survival and overall survival are the single most important issues to remember.’
If you recall from other articles posted on the CLL Society website, treatment with single agent TKIs does not achieve MRD negativity, however recent data has revealed that venetoclax, a BCL-2 inhibitor, does. The data continues to evolve and we’ll just have to stay tuned.
Betsy Dennison, RN 7/25/16
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