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In San Diego in December 2016 at the annual American Society of Hematology ASH) meeting, I interviewed Dr. Neil Kay from Mayo Clinic about ibrutinib resistance in patients with chronic lymphocytic leukemia (CLL).
Take Away Points:
- Although ibrutinib has dramatically improved the treatment landscape for patients with CLL with response rates in the 90% range, a significant number of patients will stop responding and eventually relapse.
- Most of those CLL patients are in the relapsed/refractory group (not taking ibrutinib as their 1st therapy) who also have indicators of genomic instability (increased likelihood to mutate) such as deletion 17p or complex karyotype.
- We now know that most, but not all, of those who relapse will have biomarkers that explain why the ibrutinib has lost its efficacy.
- These biomarkers can be found in the blood months before there is a clinical relapse, giving ample time to plan the next move.
- These biomarker tests are only available in clinical trials at this time, another strong argument for joining a clinical trial.
- There are a growing number of excellent options available for those who can’t tolerate or progress on ibrutinib.
For more detailed discussions on the mechanisms of ibrutinib resistance, an increasingly important topic for more and more patients, please give a listen to my interview with Dr. Neil Kay. Access Transcript
Brian Koffman, MD 2/21/17