Looking at Risk/Benefit in CLL

Steven Coutre, MD:Part of the conversation you have with your patient is the risks and benefits of each of the therapies that you’re discussing. Let’s use bendamustine plus rituximab as an example. It is a time-limited therapy, twice a week, 6 months in a row, and carries some risk of myelosuppression and some risk of infection. That infection might lead to hospitalization in some cases in order to treat that infection. There’s also the need to come in for the infusions. Most patients respond to some degree, and the expectation would be that that response duration is about 3 years, maybe 3.5 years. That’s the data we have with bendamustine and rituximab up front. Remember that the patient is still young, so you’re going to be facing another treatment decision in the not-too-distant future.

Then we have ibrutinib, and we know that these patients respond. Virtually every patient is going to respond to the treatment. Primary resistance is really virtually unheard of, and most patients are not going to stop the therapy or be unable to derive the benefit because of an adverse event, at least with their initiation of treatment. For an oral drug, you can take a pill, and you don’t have to come in. The potential drawback for now is it’s continuous therapy. We don’t have any recommendations at this point as far as how long somebody needs to take the treatment. That’s a question that patients often ask, and it’s something that we’re addressing in ongoing trials.

Case Scenario:Ibrutinib in Younger, Unfit Patients with Newly-Diagnosed CLL