Richard R. Furman, MD, Morton Coleman, M.D. Distinguished Associate Professor of Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, discusses the use of prognostic markers in the treatment of patients with chronic lymphocytic leukemia (CLL).

The goal is to make it so that prognostic markers are no longer prognostic, which is actually a good thing for the field, Furman explains. This is because with the current novel therapies available, there are responses amongst all patients. The question, however, is how long will these responses last?

Furman says that the hope is for researchers to identify which patients may require more aggressive treatment than a BTK inhibitor or a BCR antagonist alone. These patients may also be at an increased risk for developing Richter's transformation. Therefore, they may require a different treatment approach in order for them to have long-term and positive outcomes.

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Dr. Furman on Utility of Prognostic Markers in CLL

Richard R. Furman, MD, a member of the Lymphoma/Myeloma Service in the Division of Hematology/Oncology at the New York Weill Cornell Medical Center, discusses the ability to avoid the administration of chemotherapy when using novel agents, such as idelalisib, to treat patients with chronic lymphocytic leukemia.

The administration of novel agents rather than chemotherapy avoids several adverse events, Furman states. As a result, even though the trial exploring idelalisib was completed in patients with comorbidities who were not eligible for chemotherapy, Furman believes idelalisib is still a reasonable option even for patients who are eligible for chemotherapy.

Without the administration of chemotherapy, many side effects are avoided, such as immunosuppression, myelosuppression, and the long-term risk of bone marrow failure and secondary cancers. The avoidance of these side effects should prompt all physicians to consider obfuscating chemotherapy from treatment strategies whenever possible, Furman states.

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Richard R. Furman, MD, from the New York Weill Cornell Medical Center, discusses the ability to avoid the administration of chemotherapy when using novel agents, such as idelalisib, to treat patients with chronic lymphocytic leukemia.

Dr. Furman on Avoiding Chemotherapy With Idelalisib

Richard R. Furman, MD, director of the Chronic Lymphocytic Leukemia (CLL) Research Center and a senior member of the Center for Lymphoma and Myeloma at the Weill Cornell Medical Center, discusses the safety profile of the oral BTK inhibitor ibrutinib in both relapsed/refractory and treatment naive patients with CLL.

A preliminary phase II trial examining ibrutinib as a monotherapy in refractory populations found impressive response rates, states Furman. However, in this population there was a great deal of toxicities, including secondary myelodysplasia and AML, Richter's transformation, or infections. These added toxicities were due to the large amount of prior therapies that patients had received, Furman explains.

These toxicities prompted a phase II study looking at ibrutinib in previously untreated patients with CLL. In General, Furman explains, this trial did not find any clear ibrutinib-associated toxicities. Overall, the trial found the agent to be well tolerated and reasonably safe.

The phase III trial examining ibrutinib is currently underway. Furman is optimistic that this trial will lead to the FDA approval of ibrutinib in CLL.

Richard R. Furman, MD, from the Weill Cornell Medical Center, discusses the safety profile of the oral BTK inhibitor ibrutinib in both relapsed/refractory and treatment naive patients with chronic lymphocytic leukemia. 

Richard R. Furman, MD

Articles

Dr. Furman on Utility of Prognostic Markers in CLL

Dr. Furman on Avoiding Chemotherapy With Idelalisib

Dr. Furman on Trials Examining Ibrutinib's Safety in CLL