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Outside of clinical trial, in what settings would you use these novel agents for WM?Outside of clinical trial, in what settings would you use these novel agents for WM?In what situations, if any, would you attempt to use ibrutinib for WM outside a clinical trial setting? In what situations, if any, would you attempt to use carfilzomib for WM outside a clinical trial setting?
Answer: Ibrutinib: NA; Carfilzomib: NA
I have not been actively caring for patients with WM in recent years and I prefer not to comment.
Answer: Ibrutinib: Up-front and relapsed; Carfilzomib: Relapsed
If ibrutinib were to be reimbursed by insurance companies for the treatment of WM, I believe that would be a good strategy. I would recommend it in the up-front setting. However, I don’t believe that it would be reimbursed. So for that reason I would offer it only in the relapsed setting. Carfilzomib I would use for patients whose disease has relapsed.
Answer: Ibrutinib: Relapsed, after other therapies exhausted; Carfilzomib: Relapsed, after other therapies exhausted
I would consider ibrutinib for patients who are elderly and frail for whom bortezomib toxicity is a concern because they have preexisting neuropathy or marginal blood cell counts. I would make sure that I’ve exhausted all other options. We have an off-label committee, so we might petition them for use of ibrutinib because data with this drug are promising. However, it is still too early in investigation to consider. Carfilzomib might also be effective in WM. It may work better as part of a combination. However, data in the literature are not sufficient to support its use.
Answer: Ibrutinib: Up-front or relapsed; Carfilzomib: BTZ planned but significant neuropathy
There is encouraging activity with ibrutinib and oprozomib in WM. A study by Treon and colleagues showed a fairly high response rate with ibrutinib in patients with relapsed or refractory WM. Although data with ibrutinib are promising, it is still early in investigation. I would consider using carfilzomib for patients who would be good candidates for bortezomib and who have significant neuropathy.
Answer: Ibrutinib: Too early to say; Carfilzomib: Too early to say
In Europe, ibrutinib and carfilzomib have not been approved for WM outside of a clinical trial, so we cannot administer it. These agents have good potential in the future, but we need long-term data about the efficacy of these agents in WM.
Answer: Ibrutinib: NA; Carfilzomib: NA
I am not comfortable answering as I do not treat WM.
Answer: Ibrutinib: Relapsed; Carfilzomib: Relapsed
I would consider administering ibrutinib for patients with relapsed WM. We have good data with carfilzomib, rituximab and dexamethasone for WM in the up-front setting. Neuropathy is a problem for patients with WM. If that study as up-front therapy continues to show promise and patients fare better with a carfilzomib-containing regimen, that’s a setting in which I would consider using it. I would definitely recommend carfilzomib for patients who have experienced relapse.
Answer: Ibrutinib: NA; Carfilzomib: NA
I do not treat WM. |
