Cancer Conference Update: A Multimedia Review of Key Presentations from the 2016 American Society of Hematology Annual MeetingAbstract 637: Venetoclax monotherapy for patients with CLL and disease progression during or after treatment with ibrutinib or idelalisib
3:28 minutes.
TRANSCRIPTION:
DR FLOWERS: Venetoclax is now approved for patients with CLL who have 17p deletion, where it showed clear benefits that led to its approval. Venetoclax also has activity in other settings, both for patients with CLL without 17p and in other B-cell malignancies, particularly mantle cell lymphoma, where we’ve seen that it’s active. And so I think that we need data from trials like this to be able to address those other situations where venetoclax may be of benefit to patients. In this study, patients were enrolled into a trial looking at venetoclax as a therapy for patients that had failed either ibrutinib or idelalisib. And when you look at the benefits in this particular patient population for those who had received ibrutinib as their prior therapy, 30 of the 43 patients, or 70% of those patients, responded to venetoclax. When you look at the patient population who’d received prior idelalisib, 62% of those patients, responded to venetoclax. We still do need to see a little bit more data on how long those benefits last, in terms of how durable those responses are. But we’re again talking about patient populations that oftentimes are multiply relapsed, particularly after they’ve failed effective agents like ibrutinib and idelalisib. And to now have another oral agent that we can apply in those settings for CLL is really a major advance. DR LOVE: Again, are these data impressive enough that you could visualize using venetoclax. A common situation would be after ibrutinib. DR FLOWERS: I think after patients fail ibrutinib, the other agents that are out there that are approved in that setting are idelalisib, which has toxicities that now we’re aware of in terms of the diarrhea and pneumonitis and other toxicities that are of concern. And venetoclax, particularly with these data, is another agent that docs should reach for as an option for that patient population who’ve failed ibrutinib. DR LOVE: I’m kind of curious, now that venetoclax is approved, I’m sure you have a lot more clinical experience with it. What have you seen now, the last 6 months and a year, particularly in terms of tumor lysis syndrome? DR FLOWERS: So I think it still is very important to be cautious about tumor lysis syndrome. We cannot become complacent with drugs that are oral agents just because they’re oral, to think that they’re going to be less toxic. And I think, for patients who receive venetoclax, particularly those who have very high tumor burden or have a very high white blood cell count, venetoclax is still an agent where you need to be aggressive about oral and IV hydration, and including admitting patients to the hospital, to start low and to gradually ramp up their dose of venetoclax. I have seen some tumor lysis syndrome in patients with CLL, particularly those with very high tumor burden, where if you don’t pay attention to those details that those patients could have gotten in trouble. And so you need to be aware of that. That’s not the patient that you start on an oral therapy and tell them to come back and see you in a month. |