Hope for CLL

iStock_000022047429_MediumChronic lymphocytic leukemia, abbreviated CLL in medical parlance, may have met its match with a new drug described in NEJM that Rick and I discuss on PodMed this week.  And since CLL affects mostly older individuals, a burgeoning population both domestically and globally, this is good news indeed.

The drug is called ibrutinib, and it is the first-in-class inhibitor of an enzyme known as Bruton's tyrosine kinase. The enzyme is known to be essential in survival and proliferation of immune cells gone awry in this type of blood cancer. Previous studies utilized ibrutinib along with other agents in people who had relapsed, or as primary therapy in patients having a specific genetic abnormality. This study used the drug in older, previously untreated patients. A total of 269 treatment naive subjects with CLL were randomized to either ibrutinib or chlorambucil. Improvements were seen in progression-free survival, overall survival, response rate, and hematologic variables.  Additionally, the oral agent was well-tolerated and associated with relatively mild side effects, including nausea, cough, diarrhea and fatigue, with 87% of patients in the ibrutinib group continuing to take the medication. Bill Nelson, director of the Kimmel Cancer Center at Johns Hopkins, calls this study practice-changing, and Rick points out in the podcast that among this group of people, who frequently have at least one other medical condition, the arrival of an effective agent with few side effects is terrific.

Other topics this week include CDC recommendations of opioid prescribing, a failure to counsel young women who are taking drugs associated with fetal malformations about contraception in Pediatrics, and use of electric fields in glioblastoma treatment in JAMA. Until next week, y'all live well.

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