ERIC 2018: Dr. Stilgenbauer on Sequential and Combination Therapies in chronic lymphocytic leukemia (CLL)
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Dr. Kanti Rai is a legend in the CLL world for his decades of groundbreaking research in chronic lymphocytic leukemia. We still use his original “Rai” staging because it still works and helps patients and doctors to plan for their future.
Dr. Rai is also famous for his uncanny ability to keep his patients alive, which is a very good thing.
No one else has the depth and breadth of perspective on CLL as does Dr. Rai, so when he talks about the unmet needs of the CLL patient, we should all listen:
Here are his thoughts from our interview at the ERIC Meeting in Barcelona in 2018:
Takeaways:
- Despite all of the improvements in treatment, CLL remains largely an incurable cancer:
- CAR-T therapy has pulled patients from near the grave, but the results are inconsistent.
- Stem cell transplants are too toxic and also not predictably effective.
- The new targeted therapies, while offering deep and durable remissions, have yet to prove that they can cure CLL.
Discussion:
While there are definitely some low risk IgVH mutated CLL patients who may be cured with FCR and a significant percentage of transplant patients are living for decades disease free, the numbers are tiny and only applicable to small subsets of CLL patients.
CAR-T therapy is way too early to brag about being curative, even though there are now a couple of patients > 7 years out without disease re-occurrence. Many are not so lucky.
While it is unlikely that any single drug will prove curative, there are potent combinations of novel therapies and powerful antibodies that are knocking the disease back to such low levels that there is reason to believe it will never come back, but that too is yet to be proven.
Lots of promise, little proof. But the future looks bright if we keep doing the necessary research.
Finally, one might argue, if we can control the disease for years without eradicating it and offer patients a normal life expectancy, isn’t that all we want?
Here is Dr. Rai from the 1st meeting of ERIC in Barcelona, Spain in 2018.
Thanks. I have my own thoughts on the unmet needs in CLL that I will share in a separate commentary.
Stay strong. We are all in this together.
Brian Koffman MDCM (retired)
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