It’s every chronic lymphocytic leukemia patient’s dream: Take some pills every day for a few years and you’re done with blood cancer. No more chemotherapy, no more bone marrow transplants and enjoy a long and normal life with a disease controlled in the same way as diabetes.
In a conversation at the December 2018 ASH meeting with Dr. Brian Koffman, chief medical officer and EVP of the CLL Society, he and Dr. Richard Furman at Weill Cornell Medical College discuss whether patients using the new novel agents can successfully stop treatment after a fixed amount of time.
Dr. Furman is Director of the CLL Research Center, and Associate Professor of Medicine, at Weill Cornell Medical College, in New York, NY. His area of focus is on the development of non-chemotherapeutic approaches to treating CLL and has played an integral part in the development of ibrutinib and idelalisib. http://vivo.med.cornell.edu/display/cwid-rrfurman The CLL Research Center is currently running seven clinical trials testing novel agents and ideas in the treatment of CLL.
The CAPTIVATE clinical trial is testing the theory that combining two potent novels agents can result in limited duration treatment.
Since ibrutinib was officially approved by the Food and Drug Administration in early 2014, and venetoclax in 2016, initial anecdotal evidence suggests an exciting future milestone for CLL patients using these novel agents, especially combined or in sequence—after a few years of daily dosing, the level of blood cancer can become undetectable.
Drs. Koffman and Furman say CLL patients should be extremely cautious about discontinuing treatment at this time outside of a clinical trial. They say it will be several years before the clinical trials have generated enough data for doctors and patients to take that step.
Key Take Aways
- “It’s true we have achieved very very deep remissions with venetoclax and venetoclax and ibrutinib combinations,” notes Dr. Furman. “There are trials underway to see when and if you can discontinue the drugs and not have people relapse. Or if they relapse, whether or not we can rescue them.
- “Until we have those data,” Dr. Furman adds, “I believe it is important for everyone to remain on their therapy as long as is necessary.”
- The CAPTIVATE study, launched in late 2016, includes treating patients with both ibrutnib and venetoclax in a specific sequence and in two separate groups. There are 300 patients at 39 sites around the world. The patients are divided into two different groups, looking to see if it is safe and possible to discontinue therapy after achieving an undetectable level of CLL. These patients were selected with the following characteristics: they were treatment-naïve, less than 70 years old and who needed treatment. (For more details on the clinical trial protocol, see: https://clinicaltrials.gov/ct2/show/NCT02910583)
- “It will be a few years until we have answers to these important questions,” Dr. Furman noted.
Though we only have very preliminary results from CAPTIVATE, what we have was published as an abstract in the Journal of Clinical Oncology is promising.
Dr. Nitin Jain from MDACC presented this abstract at ASH 2018: Combined Ibrutinib and Venetoclax in Patients with Treatment-Naïve High-Risk Chronic Lymphocytic Leukemia (CLL) that probes the same question.
Here is the interview:
I know many CLL patients using venetoclax and/or ibrutinib, and we are all eagerly awaiting the results of our own blood work as well as the clinical trials testing the limited duration theory. When I think of the progress made in treating CLL over the past decade, and my own journey from pessimism to optimism, I am left with a profound sense of gratitude.
Thanks for reading
Larry Marion is a CLL survivor who has been using ibrutinib for more than five years. He begins venetoclax treatment in May, in the hope that he may be able to terminate anti CLL drug consumption one of these days. Marion is a former science writer and editor for various business and technology publications.