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Dr Richard Furman: A new alternative for treating CLL

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Dr. Richard Furman, from Weill Cornell Medical College, in New York

A new alternative to chemotherapy for treating Chronic Lymphoid Leukemia




Hello! You’re on MD-FM INSIGHT, the first medical web radio. Today we’ll be devoting our "Question & Answer" program to the treatment of patients with relapsed Chronic Lymphoid Leukemia (or CLL) –the most common type of leukemia in adults.


Treatment options are limited for patients with relapsed CLL or CLL refractory to chemotherapy - particularly elderly patients and those with comorbidities. The CD20-targeting drug rituximab is often used to treat such patients when their cancer returns, however, its benefits typically do not last.


At the 2013 annual meeting of the American Society of Hematology, which took place last December in New Orleans, Dr. Richard Furman, from Weill Cornell Medical College in New York, presented the results of a phase III study evaluating a new first-in-class oral kinase inhibitor: Idelalisib. Dr. Furman then gave MD-FM the details…




Hello Dr. Furman, first of all, can you tell us about this new compound idelalisib? 



“Idelalisib is a member of the tyrosine kinase inhibitor class of compounds, and the important part of the tyrosine kinase is going to be which enzyme it inhibits. So, idelalisib inhibits the phosphoinositide 3-kinase delta isoform. What’s so important about that is this is an enzyme, PI3-kinase, that’s in every cell in the body, and plays a key role in cell growth in every cell in the body. What’s actually worked out very nicely is that the delta isoform is really only found in leucocytes, and turns out to be really most important in the malignant lymphocytes. So inhibiting delta specifically has allowed us to control the malignant disease, with minimal toxicity”.



So can you tell us about the study you presented during the meeting?



“Yes, so the study that we presented was looking at idelalisib + rituxan vs. placebo + rituxan. And what it demonstrated was, at the first interim analysis, that progression-free survival for idelalisib + rituxin had not been met, but the medium progression-free survival for placebo + rituxan was 5.5 months with a hazard ratio of 0.15, really showing a dramatic improval in progression-free survival with idelalisib + rituxan.”



So what did you find, can you tell us about your main results?



“Yes so the drug is highly effective and very well tolerated and I think that the prospects for the drug going forward are really to see that this drug get used as a means to avoid giving patients chemotherapy. So the study that we just did was actually in medically unfit patients: these were patients who had a cumulative illness rating score of greater than 6, or patients who had problems with kidney function, or patients who had other comorbidities that really precluded them from getting additional chemotherapy. This drug works very nicely in that population, we have data from other studies showing that the drug just works and we would certainly expect that now that we have a drug that’s very effective and well tolerated, that we should be using it in all of our patients including the medically fit patients.”



Ok so what is your take home message?



“My take home message is that this is a great opportunity and a great change in the treatment paradigm for patients with CLL, where we can now give them very effective therapy that’s not chemotherapy and therefore spare them the risks of all subsequent toxicities that are associated with chemotherapy, like myeloid dysplasia and secondary AML, which really would preclude our patients from having prolonged survival.”




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Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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