tag:blogger.com,1999:blog-3165131923857031708.post8080659872634180807..comments2023-08-28T02:56:25.402-07:00Comments on Dr. Sharman's CLL & Lymphoma Blog: Frontline Survival Benefit for IbrutinibUnknownnoreply@blogger.comBlogger7125tag:blogger.com,1999:blog-3165131923857031708.post-25577447710058715142015-10-21T08:07:15.113-07:002015-10-21T08:07:15.113-07:00I second JZ's comment aboveI second JZ's comment aboveAnonymoushttps://www.blogger.com/profile/10120671334154782042noreply@blogger.comtag:blogger.com,1999:blog-3165131923857031708.post-55483844133555331652015-10-19T16:23:08.880-07:002015-10-19T16:23:08.880-07:00Doc I miss your blog. Please come back. Doc I miss your blog. Please come back. Jeffrey Zuckermanhttps://www.blogger.com/profile/17235540247201415923noreply@blogger.comtag:blogger.com,1999:blog-3165131923857031708.post-73437116033644543482015-08-23T13:53:55.855-07:002015-08-23T13:53:55.855-07:00I am 67, was diagnosed with CLL this summer after ...I am 67, was diagnosed with CLL this summer after a bout with septic shock.<br />I am enrolled in a study, and was chosen to go Ibrutnib.<br /><br />Wow! No side effects, and if I watch my diet with care I do not have the slightest discomforts. Hope this continues!<br /><br />bob hertz<br />St Paul MNbob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.comtag:blogger.com,1999:blog-3165131923857031708.post-46240768038845945482015-06-06T14:24:56.757-07:002015-06-06T14:24:56.757-07:00While the crossover mitigates the trial design, th...While the crossover mitigates the trial design, there is still a survival benefit according to the press release - so the mitigation is incomplete.<br /><br />I don't want to say that chlorambucil is Never appropriate. There may be some extremely elderly individuals age 90+ who are intolerant of ibrutinib. In that case, I would be trying to give it in combo with obinutuzumab where another survival benefit has been shown.JAGhttps://www.blogger.com/profile/13844336136808999715noreply@blogger.comtag:blogger.com,1999:blog-3165131923857031708.post-8610915074171654352015-06-06T14:22:37.737-07:002015-06-06T14:22:37.737-07:00This data set does not answer your question direct...This data set does not answer your question directly and there are prospective trials comparing Ibrutinib to Ibr-Rituxan to FCR and another compared to BR. Until those data sets emerge, I think it will be hard to extrapolate although if the PFS curve on this is outstanding, we will be tempted to try.<br /><br />My bias toward aggressive chemo in most favorable patients stems from both the long term follow up at MDA and the German CLL8 study. Although the MDA dataset heavily skewed in favor of the most physicially fit, there are some patients out 14 years remaining MRD negative. If you look at the German CLL8 study and select only the most genomically favorable group, they are close to 70-80% progression free at 8 years and if likely to continue to do well. Some have asked if these patients are possibly curable. Hate to pass that up if available.<br /><br />If you are going to try to identify the super low risk though, would also look for TP53, SF3B1, and NOTCH1 mutations not detected by FISHJAGhttps://www.blogger.com/profile/13844336136808999715noreply@blogger.comtag:blogger.com,1999:blog-3165131923857031708.post-44601135299490534332015-06-06T04:51:20.017-07:002015-06-06T04:51:20.017-07:00Excellent piece, thank you. Points all well taken...Excellent piece, thank you. Points all well taken and stated. Regarding chlorambucil as a control therapy in upfront CLL, do you feel that the crossover provision mitigates the "dead dog" ethical issue you describe? Is Chlorambucil still listed as appropriate for first line therapy on NCCN guidelines? Should it not be? Is it fair to say it's the least-toxic or easiest to tolerate cytotoxic protocol for CLL? (Karl, Patients Against Lymphoma)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3165131923857031708.post-82769312678428735642015-06-04T18:23:58.258-07:002015-06-04T18:23:58.258-07:00Do you think the standard of care for untreated lo...Do you think the standard of care for untreated low risk patients will move away from FCR and B+R anytime soon? Secondary cancers, even in a fit younger population, are still are out there, with no predictors as to who is most vulnerable to Richter's or MDS. <br /><br />Would using Novel Inhibitors initially in low risk patients needing treatment be a higher standard of do no harm compared to FCR? More directly, if one is "failing" one of this or a combination of these drugs would it not be possible to get FCR at that stage? <br /><br />Thanks for all you post here and giving folks access to your presentations. And congrats on your early work on Novel Inhibitors. <br /><br />Super Fit 58 year old with low risk but growing CLLAnonymousnoreply@blogger.com