What is the importance of achieving good dose intensity in this patient?
The clinical trial has shown that the use of three pills, in this case, 460 mg/day of ibrutinib, is the optimal dosing to achieve the best response. However, there is no doubt that some patients may [experience] side effects, acute or chronic, [which] may decrease quality of life. Patients may ask, or doctors may consider, dose reduction when these side effects negatively affect quality of life of CLL patients that relapse.
Case 1: Relapsed and Refractory CLL
Robert is a 63-year-old retired civil engineer from Houston, Texas. His medical history is notable for mild hypertension and for an acute appendicitis and appendectomy in 2010. He presented to his PCP in September 2012 with symptoms of intermittent fatigue and abdominal discomfort.
On physical examination, Robert showed moderate splenomegaly (12 cm), lymphadenopathy, and CBC showed elevated WBC count of 98 x 109/L, with 80% lymphocytes, and anemia (Hb 11 g/dL).
He was referred to an oncologist for further evaluation and was subsequently diagnosed with (CLL); peripheral blood flow cytometry showed mature B lymphocytes CD5+/CD23+.
Interphase cytogenetic analysis showed 17p13.1 deletion
He was initiated on chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR) in October 2012
After 5 cycles he displayed a complete response, with disappearance of palpable disease, normalization of blood counts, and no evidence of disease on bone marrow biopsy and CT scans.
In January 2015, he presented to his oncologist with symptoms of worsening fatigue and abdominal distension.
Marks Explores Cardiac Toxicities and Dosing Concerns of BTK Inhibitors in CLL
April 26th 2024During a Case-Based Roundtable® event, Stanley M. Marks, MD, moderated a discussion on the impact of cardiac adverse events on patients who receive a Bruton tyrosine kinase inhibitor for chronic lymphocytic leukemia.
Read More
Considering the Durability of Zanubrutinib in Relapsed/Refractory CLL
April 11th 2024During a Case-Based Roundtable® event, Marc S. Hoffmann, MD, discussed his viewpoints on the use of Bruton tyrosine kinase inhibitors for patients with relapsed/refractory chronic lymphocytic leukemia and the efficacy behind zanubrutinib in the second article of a 2-part series.
Read More
Acalabrutinib/Obinutuzumab Shows Improved PFS in Treatment-Naive CLL
April 10th 2024In an interview with Targeted Oncology, Jeff Sharman, MD, discussed the results of the ELEVATE-TN trial of acalabrutinib with or without obinutuzumab at 74.5 months of follow-up among patients with chronic lymphocytic leukemia.
Read More