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ASH 2018: Dr. Furman on the evolving role of clinical trials in CLL

In science and medicine, information is constantly changing and may become out-of-date as new data emerge. All articles and interviews are informational only, should never be considered medical advice, and should never be acted on without review with your health care team.

ASH, short for the American Society of Hematology Annual Meeting and Exposition, is the showcase for the latest and best results from the research, mostly clinical trial data, in hematology.

But the function of clinical trials is changing for CLL patients, at least in the opinion of one of the top researchers in chronic lymphocytic leukemia, Dr. Rick Furman from Weill Cornell in NYC.

At ASH 2018 in San Diego, I interviewed Dr. Rick Furman, who serves on the CLL Society’s Medical Advisory Board.

What I like about Dr. Furman is how he critically exams all issues to discover how they really benefit patients. Nothing is off limits including the importance of clinical trials.

Take Aways:

  • Clinical trials are the best way to move forward in researching what are the best treatment options in CLL.
  • Furman personally sees little role for the many clinical trials presented at ASH 2018 (we will be presenting interviews with the investigators later) that added a novel agent such as ibrutinib or duvelisib to a chemo-immunotherapy regime in the hopes of both increasing the efficacy and lowering the toxicity. The way they plan to improve the latter is to reduce the number of cycles of the chemotherapy.
  • There are several potential issues with this research:
    • Responses rates are already very high and durable with the novel agents, especially in the frontline setting, suggesting little possible benefit and significant risks with adding chemo.
    • There is no guarantee that reducing the amount of chemo will reduce the associated adverse events, especially the long-term ones, though it does make sense that it might.
  • Not that many years ago, the only access to novel therapies was through a clinical trial, but now there are several excellent medications that can be prescribe outside of a clinical trial.
  • Clinical trials are for patients, not the other way around so it is important that when entering a trial, you can check off at least some of these boxes:
    • It answers clinically relevant unanswered questions in CLL.
    • It makes sense for you. In other words, if there is an existing approved therapy that offers you odds that you like, then you need to carefully examine the upside of yourself for yourself.
    • One potential advantage might be a shorter course of therapy or better outcomes for your particular type of CLL.

Summary:

The role of clinical trials is changing in CLL in the era of novel therapies, but we still have many unmet needs for chronic lymphocytic leukemia patients and we will only get answers in well-designed ethical clinical trials.

I am alive with no measurable CLL (U-MRD) today because of the two clinical trials that I entered. The world has changed since those trials, especially the first one started in 2012, but I believe clinical trials are still needed to improve management of CLL.

Here is my interview with Dr. Furman from the third day of ASH 2018 in San Diego, CA

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