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Dr. Bill Wierda heads the powerful CLL team at MDACC in Houston, TX that is responsible for much game changing research and cares for many chronic lymphocytic leukemia patients not just from Houston but from around the world.
When he was scheduled to give the CLL talk at NCCN 12TH ANNUAL CONGRESS: HEMATOLOGIC MALIGNANCIES in 2017 held in San Francisco, I grabbed this audio only interview about chronic lymphocytic leukemia.
Our subject was that there are still significant unmet needs despite the amazing advances in CLL care.
The first point Dr. Wierda makes is the same one I made last week. Patients who get ibrutinib frontline have very durable responses and don’t tend to relapse. See this on frontline ibrutinib and don’t miss the graph.
However, patients who take ibrutinib as second line therapy tend to relapse earlier and be more difficult to treat. This is particular true for those with deletion 17p and/or complex karyotype. I am one of those patients. These markers are considerably less important frontline.
The treatment of patients relapsed after ibrutinib is a growing critical unmet need in CLL.
Dr. Weirda discusses the options for patients who relapse on ibrutinib for their CLL.
- First Dr. Wierda makes the bold statement that venetoclax is the standard of care for CLL patient who relapse on ibrutinib.
- The best options however may be a clinical trial and here are some that are happening at MD Anderson and elsewhere.
- SNS062 by Sunesis is another BTK blocker similar to ibrutinib but binds differently so that it may overcome the common mutations that lead to resistance to ibrutinib. Here is a link to our story on that research.
- CAR-T directed in collaboration with JUNO directed at CD19. This is very similar to what I did when I relapsed on ibrutinib as detailed in our CAR-T section of the website.
- CAR-NK directed at CD 19 from cord blood. Here is the background.
- Cirumtuzamab, an antibody against the embryonic antigen, ROR1 that is found on chronic lymphocytic leukemia cells and other cancer cells, but not on normal cells. Dr. Kipps explains all the excitement over ROR1 in this interview.
- PD1 antibody or check point inhibitor (ipilimumabor trade name Yervoy) have been not helpful in CLL but work about in about 40% of Richter’s Transformation which is not great, but better than many other options. These are monoclonal antibodies that activate the immune system by taking off a “brake” called CTLA-4 that otherwise suppresses the immune system. Dr. Pagel reviews the early data here.
- Blinatumomab, a bispecific T-cell engager antibody construct targeting CD3 on T cells and CD19 on B cells. is also being investigated for Richter’s. For more on its use in acute lymphoblastic leukemia (ALL) and also a nice if somewhat scientific introduction to this powerful antibody, see https://www.nejm.org/doi/10.1056/NEJMoa1609783.
The plethora of clinical trials tells us that patients such as myself who relapse after ibrutinib have difficult choices to make and a clinical trial may be their best option. It was for me.
Thanks for reading.
Stay strong. We are all in this together.
Here is my audio interview with Dr. Wierda.