In this video, Dr. Brian Koffman, MDCM, a CLL patient, family physician and Chief Medical Officer of the CLL Society, interviews Dr. Alexey Danilov, MD, PhD, a practicing hematologist and Associate Professor of Medicine, at Oregon Health and Sciences University (OHSU). This interview occurred at the European Hematology Association (EHA) Congress, in Amsterdam, Netherlands, earlier this year.
With the average age of onset of CLL at around 70-years of age, it is common that patients have other underlying illnesses or “co-morbidities” at the time of diagnosis. Dr. Danilov finds the average number of co-morbidities to be 2-3 with more than half the patients having some additional serious illness.
In addition, there are many drug interactions between drugs used to manage underlying illnesses and the targeted therapies. As a practicing pharmacist (with CLL), I found it refreshing to hear Dr. Danilov, credit his Clinical Pharmacy team with helping him and his colleagues select the best treatment for CLL to minimize potential interactions and negative outcomes.
There is a risk of immune suppression and corresponding higher risk of infections, as well as known cardiac toxicities with some chemotherapy regimens making them too toxic for a number of older patients with existing medical issues that could be worsened as a result of treatment.
The advent of targeted therapies, most notably ibrutinib (Imbruvica®), showed promise as being a less toxic alternative treatment for CLL and its use has grown. Dr. Danilov states that patients with higher Cumulative Risk Factor Scores (CIRS), which is determined by the number and severity of co-morbidities, are more likely to need to need to stop treatment and therefor may have lower survival.
Dr. Danilov conducted a study of patients, receiving idelalisib (Copiktra®) in which patients with higher CIRS scores had shorter Progression Free Survival (PFS) and lower response rates than healthier patients. Interestingly, patients with higher CIRS did not have any difference in the rate of not being able to tolerate the medication necessitating discontinuation. Further, they found that patients on idelalisib did better in both response rate and PFS than patients on rituximab alone.
Idelalisib is currently approved for relapsed or refractory disease but Dr. Danilov makes a compelling argument that physicians should be able to use this and other drugs, earlier where currently approved first line therapies might fail.
For more information on idelalisib, see my article https://cllsociety.org/2018/03/things-to-know-about-idelalisib/.
Please enjoy Dr. Koffman’s interview from EHA 2019 with Dr. Danilov:
Clinical Pharmacy Advisor, Lumere
President and Senior Consultant, Burlington Consulting Associates
Has served as Chief Pharmacy Officer at two Top-15 Comprehensive Cancer Centers, Moffitt (Tampa, FL) and Roswell Park, (Buffalo, NY)