ASCO 2016: Number of Prior Lines of Therapy Effects Outcome in Those Who Stop Ibrutinib

At ASCO 2016, Dr. Susan O’Brien of the U. of California Irvine (UCI) was the lead author on an important paper that cleared up some confusion about what happens when patients come off ibrutinib.

There has been data suggested that when patients failed ibrutinib, the outlook was dismal.

Dr. O’Brien explains that finding and offers a broader and more upbeat perspective based on her study presented at ASCO 2015.

Take Away Points:

• Both frontline and relapsed patients have high responses rates on ibrutinib and relapses are rare. This is not news.
• More of those who start ibrutinib after having relapsed from multiple other prior therapies fail on ibrutinib. Again this is not news.
• Patients from the early trials that relapsed after multiple lines of therapy on ibrutinib obviously had very few options and also had aggressive disease explaining their poor outcomes.
• However the few patients who fail ibrutinib after no or only one line of prior therapy do very well post-ibrutinib. Median survival has not yet been reached. Some may not need therapy for a long time.
• These patients have many options now that both approved and within clinical trials that were not available until very recently.

When we read trial results, it is critical that we understand who the patients are that are being studied and not to generalize the data to all patients who might take the trial drug in other circumstances. This is another argument for the importance of having a CLL expert on your team who closely follows the research.

Here is the abstract.

Enjoy the video.

This is good news and it should only get better as more targeted options are approved.

Brian Koffman, MD  9/12/16