EHA 2019 | CLL progression since ASH 2018

CLL treatment since ASH in 2018, which is just six months ago, should be radically changed by the reports that were presented at ASH on the ALLIANCE and the ECOG trials, both of which showed that an ibrutinib backbone therapy, in other words a non-chemo, small molecule, BTK inhibitor therapy was superior to the gold standards, both in an older and younger population. In the younger population, fludarabine, cyclophosphamide, and rituximab, commonly known as FCR, and in the older population, bendamustine and rituximab, commonly known as BR.

So, those findings should influence what’s happening in the community. It is influencing what’s happening in most academic centers, but it has not spilled out yet to all the communities, both in the US and especially beyond the US, so changes should be happening, but they haven’t happened fully yet.

What needs to happen in order for CLL treatment to catch up with the latest science depends on where you are. So in the US we believe at the CLL Society that what you need to do is educate patients so that they’re aware, but also educate the community hematologists, who may not have the time to be on top of all the latest developments in CLL, to be aware of what the advantages and disadvantages of chemotherapy versus a novel agent, such as ibrutinib, is. That’s in the US.

In other countries the issue is more, patients have to advocate and physicians have to advocate to get these drugs approved in a frontline setting. A lot of places there’s financial issues and other reasons these drugs are yet to be approved for the bulk of patients that they would benefit.