Julio Chavez, MD, assistant member, Lymphoma Section, Department of Malignant Hematology, Moffitt Cancer Center, discusses the use of blinatumomab (Blincyto) in patients with acute lymphoblastic leukemia (ALL).

In March 2018, the FDA granted an accelerated approval to blinatumomab for the treatment of adult and pediatric patients with B-cell precursor ALL who are in remission but still have minimal residual disease (MRD).

Blinatumomab is a bispecific antibody that targets the CD19 antigen in B-cell malignancies, specifically B-cell ALL, says Chavez. A randomized clinical trial compared the agent to standard of care chemotherapy in patients who relapsed after 1 or 2 lines of therapy as well as in patients with MRD-positive status and showed great responses with the therapy. MRD positivity is indicative of poor prognosis, explains Chavez. However, in the phase II BLAST study, blinatumomab induced a nearly 80% complete MRD response rate in patients with MRD-positive ALL in hematologic complete remission.

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Dr. Chavez on Blinatumomab in ALL

Julio Chavez, MD, of the Department of Malignant Hematology at Moffitt Cancer Center, discusses the potential with the combination of ibrutinib (Imbruvica) and ublituximab (TGR-1101) in patients with chronic lymphocytic leukemia (CLL).

The combination was explored in the GENUINE study, results of which were presented at the 2017 ASCO Annual Meeting. Ublituximab is a monoclonal antibody that is similar to obinutuzumab (Gazyva), Chavez explains. It has shown good activity as a single agent and also in combination with other drugs.

As seen in other clinical trials of combinations with ibrutinib, Chavez says that adding ibrutinib to a monoclonal antibody like ublituximab could lead to better outcomes.

Dr. Chavez on Combination of Ibrutinib Plus Ublituximab in CLL

Julio Chavez, MD, of the Department of Malignant Hematology at Moffitt Cancer Center, shares his advice for oncologists treating patients with chronic lymphocytic leukemia (CLL).

Chavez says to assess the patient as a whole—including genetics, poor prognosis, deletion&mdash;and remember that not all patients are the same. Young, fit patients can handle an intensive therapy regimen, while those with comorbidities need to be treated differently.

Additionally, Chavez says to not discount chemotherapy. Although new agents are causing excitement, chemotherapy still produces complete responses in patients with CLL.

Julio Chavez, MD, of the Department of Malignant Hematology at Moffitt Cancer Center, shares his advice for oncologists treating patients with chronic lymphocytic leukemia.

Dr. Chavez Shares His Advice for Treating Patients With CLL

Julio Chavez, MD, of the Department of Malignant Hematology at Moffitt Cancer Center, discusses ibrutinib (Imbruvica) plus venetoclax (Venclexta) in chronic lymphocytic leukemia (CLL).

Sequential treatment is the future of CLL, says Chavez, including the combination of ibrutinib plus venetoxclax and combinations with monoclonal antibodies.

Ibrutinib plus venetoclax is an interesting combination, Chavez says, and further results will be presented at the 2017 ASH Annual Meeting to confirm its potential in this disease.

Julio Chavez, MD, of the Department of Malignant Hematology at Moffitt Cancer Center, discusses ibrutinib (Imbruvica) plus venetoclax (Venclexta) in chronic lymphocytic leukemia.

Dr. Chavez Discusses Ibrutinib Plus Venetoclax in CLL

Julio Chavez, MD, of the Department of Malignant Hematology at Moffitt Cancer Center, discusses the ongoing efficacy but also challenges with ibrutinib (Imbruvica) as treatment for patients with chronic lymphocytic leukemia (CLL).

Ibrutinib has changed the landscape of treatment entirely for CLL, Chavez explains. While it is an oral agent that is generally well tolerated, there are some toxicities to consider. These include increased bleeding, atrial fibrillation, and infections. Those are manageable but can lead to potential comorbidities, he adds. The efficacy of ibrutinib is impressive in many CLL settings, such as high-risk patients, those with 17p deletion, elderly patients, those with treatment-naïve disease, and relapsed/refractory patients.

However, there are some issues as the complete remission rates are less than 10%. It doesn’t increase with combination therapy, whether rituximab (Rituxan), bendamustine and rituximab, or chemotherapy is added, Chavez says. Moreover, deeper remissions are associated with good outcomes in patients with CLL.

Additionally, patients discontinue treatment on ibrutinib for several reasons, such as toxicity or disease progression. Recent data show that if patients progress on ibrutinib, moving to chemotherapy or monoclonal antibodies is no better than going to agents, such as idelalisib (Zydelig) or venetoclax (Venclexta). If patients fail on ibrutinib, the next step should be venetoclax.

Julio Chavez, MD

Articles

Dr. Chavez on Blinatumomab in ALL

Dr. Chavez on Combination of Ibrutinib Plus Ublituximab in CLL

Dr. Chavez Shares His Advice for Treating Patients With CLL

Dr. Chavez Discusses Ibrutinib Plus Venetoclax in CLL

Dr. Chavez on Ongoing Efficacy and Challenges With Ibrutinib in CLL