Our recent CLL Global Research Foundation Town Hall featured CLL Global President, Dr. William Wierda, and Dr. Alessandra Ferrajoli, from The University of Texas MD Anderson Cancer Center. Watch the full webinar.
Expert Panel:
Dr. William Wierda, President & CEO, CLL Global Research Foundation
Dr. Alessandra Ferrajoli, The University of Texas MD Anderson Cancer Center
Transcript
Jamie Forward:
So, Dr. Wierda, Karen sent in this question: As CLL NCCN guidelines are rapidly changing, do you have an opinion regarding the appropriate sequencing of treatments?
Dr. William Wierda:
I have an opinion about what my recommendation is for sequencing. I will start by saying there isn’t any data that shows that there is an appropriate sequencing. That’s more based on patients and what the patients and the physicians identify as the priorities and how we want to manage the disease. There haven’t been any trials that have shown that if you start with a BTK inhibitor for example, over a BCL-2 inhibitor-based therapy, there will be a difference in survival.
So, I would start by prefacing it with it’s more of a preference and strategy. My preference and strategy is to start with time-limited therapy, a BCL-2 inhibitor-based therapy. I like the concept of having patients in remission, in a deep remission and off treatment for extended periods of time rather than being on a maintenance. You can always go back and retreat if the disease comes back after a long period of remission with venetoclax-based (Venclexta) therapy, for example, and then, if you have a remission that’s not as long as what you consider optimal, then you can always switch to the maintenance.
But if you commit to starting with a maintenance, you’re pretty much committing to long-term maintenance therapy.
The median progression-free survival with ibrutinib (Imbruvica), for example, is nine years. And so, if we start with a BTK inhibitor, pretty much patients will be on treatment for the remainder of their life if we start with a BTK inhibitor. You might get a brief period of remission if you switch over ultimately to a BCL-2 inhibitor as opposed to starting with a BCL-2 inhibitor and leaving that an option to retreat later on. In those individuals, they will have extended periods of time off treatment. So, that’s my preference is having patients in remission and off treatment.