This is a few weeks old now, but it's a video of Dr. Bruce Cheson of Georgetown University, and most of you know how much I enjoy his videos.
Dr. Cheson discusses the announcement that some Idelalisib trials were being cancelled. As you can see, the usually entertaining Dr. Cheson starts out by saying "Today we have no music, we have no jokes. It is a
serious discussion." And it is.
He discusses a second treatment that has had problems in its trials -- Acalabrutinib, which apparently has had success with CLL, but not with Follicular Lymphoma. I must confess, I don't know much about Acalabrutinib. It seems like it might be gone before it ever really got going enough for me to notice. It's a BTK inhibitor like Ibrutinib. That's about all I know.
The important message from Dr. Cheson comes at the end of the video. He was asked if the problems that these meant "the end for a chemo-free world." He says, "Absolutely not." There are treatments that work, and more being developed. As problems are being seen by researchers in trials, it's clear that future versions of these treatments will need to be more carefully developed and studied to try to take care of some of those problems.
Dr. Cheson has faith in the future, and that's good enough for me.
If you try to watch the video, you may be asked for a Medscape login. Medscape is great, and I recommend joining. But if you'd rather not, Dr. Cheson included a transcript of his video, which I have copied below.
Hello again. This is Bruce Cheson from Georgetown University Hospital
and the Lombardi Comprehensive Cancer Center, speaking to you for
Medscape Hematology. Today we have no music, we have no jokes. It is a
Last week, I was in the splendid city of Rome
giving a couple of presentations at the Second Postgraduate Lymphoma
Conference. I was invited by my good friend Pier Luigi Zinzani, and was
asked to give two talks: (1) on Bruton tyrosine kinase (BTK) inhibitors
in follicular lymphoma, and (2) on how we're getting to a chemo-free
world in patients with follicular lymphoma. That's a particularly
favorite topic of mine, because I think that's really the goal of
Unfortunately, [because of breaking news] I had to make
some very last-minute adjustments to both of these presentations.
Regarding the chemo-free world, we've had an increasing number of very
exciting drugs over the past few years, and I was to talk about these
various drugs and how we put them together. Then we get this
announcement from Gilead Pharmaceuticals about their PI3 kinase inhibitor idelalisib, a very active drug for chronic lymphocytic leukemia (CLL) and indolent lymphomas.
are a number of new safety signals with that drug that have halted a
number of their clinical trials, particularly those in combination with
other agents. There have been cases of serious toxicities and
fatalities, particularly pneumocystis and cytomegalovirus (CMV)
These events tend to be more common and more severe when you combine
the drug with other agents within the first 6 or so months of treatment,
and in patients who are less heavily pretreated. The trials,
particularly those looking at upfront therapy, are gone.
[safety signal] is consistent with some other observations with this
drug that the hepatotoxicity and the diarrhea also are more common in
the upfront setting. The drug also seems to induce a neutropenia.
yes, it's a pill, and yes, it's targeted therapy. But yes, there are
adverse effects that now require close monitoring, and the company is
recommending prophylaxis for pneumocystis and frequent monitoring for
CMV—and if either of these events occurs, that's it for the drug for that patient.
second event related to my talk on BTK inhibitors. There's a great new
drug out there, acalabrutinib (ACP-196). Unfortunately, whereas it seems
to be fabulous in CLL,
[in] the trials from Acerta Pharma, [efforts to pursue indications for
acalabrutinib in combination with other drugs] in follicular lymphoma
and other indolent lymphomas, such as Waldenström macroglobulinemia, are
now terminated, [but Acerta is still conducting single-agent studies in
those disease entities because acalabrutinib is showing promising
activity with minimal toxicity]. And the company states they want to
focus on getting the drug approved in CLL [in personal communications to
Dr Bruce Cheson, as reported March 31, 2016]. That's their main
objective, and it's a laudable one, but it also suggests that perhaps
the drug is not as active as we would like to have it be in follicular
lymphoma and the other indolent histologies. Too bad.
the audience asked me, is that the end for the chemo-free world? I said
absolutely not. We have lots of new drugs coming along, venetoclax
and others, which still offer this possibility for our patients. It's
just a question of being careful, of developing newer and less toxic
second- and third-generation drugs, and putting them together in an
intelligent and safe fashion. Even though we have a couple of these
drugs on the market, they should only be put together in the context of a
carefully monitored clinical trial.
Bruce Cheson, signing off for Medscape Hematology, and I look forward to speaking to you again in the near future. Thank you.