Dr. Sunil Gandhi, Cancer & Blood Disease, 02/26/13

I saw a patient approximately 10 years ago. He was diagnosed with CLL, or chronic lymphocytic leukemia, when he came in with elevated WBC count in routine CBC done by his primary care doctor.

Leukemia is a cancer of the blood. Leukemia begins when normal blood cells change and grow uncontrollably.

Chronic lymphocytic leukemia is a cancer of the lymphocytes, a type of white blood cell involved in the body’s immune system. For about half of people with CLL, the disease grows and progresses slowly, and it may take years for symptoms to appear or for treatment to be needed. In fact, some patients may never need treatment for their CLL. The other half of people who develop CLL have a type that grows more quickly and needs treatment sooner.

Unfortunately, my patient fell into the half whose cancer progressed relatively faster.

He received various different chemotherapies through the years, including Fludarabine, Rituxan, Bendamustine and oral Revlimid. Currently, he is on Bendamustine and Rituxan and is doing fairly OK.

Recently, there was an American Society of Hematology annual meeting in Atlanta. Researchers presented data on a new and very promising drug called Ibrutinib. This is a novel drug and is not yet approved by the FDA. This works by completely new mechanism of action by targeting Bruton’s tyrosine kinase (BTK) in chronic lymphocytic leukemia (CLL). We do not have any other drug which works by this pathway.

Also, it is an oral drug the patient takes at home. In one study involving 116 patients with previously untreated or relapsed or refractory CLL, almost 70 percent showed objective responses, reported John Byrd, M.D., of Ohio State University in Columbus.

Progression-free survival (i.e., cancer did not progress after stopping treatment) after 22 months in the trial was 96 percent among the treatment-naive patients and 76 percent in those who had failed or relapsed on previous conventional therapies. This is an amazing response. Another study also confirmed a similar response rate.

Its main side effects were lowering blood count, infections and diarrhea. It may be combined with Rituxan, a drug that is available and widely used in patients with CLL. This is very amazing. Ibrutinib could quickly become the standard of care for CLL if ongoing and planned phase III trials show similar results.

As per one of the researchers: “It’s orally active, it’s well tolerated, it’s not chemo, and it produces excellent responses, particularly in patients who are elderly and frail and not necessarily suitable for the more intensive chemotherapy regimens that have become the first-line treatment for the younger, fitter patients,” she said.

“There’s a lot of excitement about the possibility of the landscape changing, and of moving towards having chemo-free treatments for patients with CLL that are as effective as giving them chemotherapy agents.”

My patient will be a good candidate for this in the future once this drug gets approval by the FDA.

Dr. Sunil Gandhi is a hematologist and oncologist. He is volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@tampabay.rr.com or call 352-746-0707.