One thing that might surprise newly diagnosed patients is that chronic lymphocytic leukemia (CLL) is generally not treated until the patient starts having symptoms. Watching and waiting might seem counterintuitive. Wouldn’t starting treatment as early as possible be the most effective? The reason CLL treatment doesn’t start immediately is that there have been many studies showing that early intervention with standard chemotherapy drugs does not prolong the length of a patient’s life. If early treatment doesn’t provide a clear benefit, there is no point in reducing the patient’s quality of life.
While early intervention with chemotherapy does not provide any survival benefit to patients, we don’t yet know if early intervention with newer targeted therapies might help.
At the annual meeting of the American Society of Hematology (ASH) 2019, our own Dr. Brian Koffman interviewed Dr. Deborah Stephens, a doctor who specializes in CLL at the Huntsman Cancer Institute of the University of Utah. They discussed the role of early intervention and some new studies that are trying to shed light on whether early intervention with targeted therapies might be useful.
Takeaways:
- The CLL12 trial is studying the use of ibrutinib as an early intervention for intermediate-risk and high-risk patients.
- Thus far, results from the CLL12 trial indicate that early treatment with ibrutinib can extend the amount of time before a second treatment is needed, but more follow-up time is needed to see if the intervention has any effects on the length of a patient’s life.
- Stephens will be leading a clinical trial that is looking at the effects of using the combination of venetoclax and obinutuzumab either as an early treatment or as a delayed treatment.
- The combination of venetoclax and obinutuzumab is a relatively short course of therapy (1 year) that was recently approved by the FDA.
Conclusions:
Watching and waiting still makes sense for patients who are low-risk. Researchers are trying to determine if early interventions with some of the new targeted therapies make sense for intermediate-risk and high-risk patients.
Please enjoy this brief interview with Dr. Stephens from December 2019 at ASH in Orlando, FL.
In the interview, Dr. Stephens mentions that the clinical trial is supposed to begin in March/April of 2020. However, as we all know, COVID-19 has completely upended our world. Many clinical trials have been stopped or put on hold due to safety concerns. While Dr. Stephen’s trial has not yet started and is likely delayed for some time, hopefully the trial will continue once it is safe to do so again.
Here is a link to the clinical trial registration listing: Testing the Effects of Early Treatment With Venetoclax and Obinutuzumab Versus Delayed Treatment With Venetoclax and Obinutuzumab for Newly Diagnosed Patients With High-Risk Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma Who Do Not Have Symptoms, the EVOLVE CLL / SLL Study
Take care of yourself first.
Ann Liu, PhD
