Expert Point of View: Constantine S. Tam, MBBS, MD

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The findings in chronic lymphocytic leukemia (CLL) were discussed by Constantine S. Tam, MBBS, MD, of St. Vincent’s Hospital in Melbourne, Australia, who observed, “There is a long list of novel agents in CLL. I think some of the most promising are those targeting the B-cell receptor pathway. This is a group of drugs that is going to completely change how we manage CLL.”

The study of ibrutinib administered as first-line therapy—in which “virtually all patients benefited, regardless of mutation status, and responses were durable”—represents a group of patients “we see in real life, older CLL patients,” Dr. Tam noted.

“Older patients now have a real chance at a nonchemotherapy treatment that is easy to take, that they can take long term, that suppresses disease long-term and that, so far, appears not to be associated with mechanisms of resistance,” he said. “And in younger patients, I think we are looking at the prospect of a cure. Patients fail chemotherapy because we are not getting rid of disease in the bone marrow and lymph nodes, where cells are protected in the microenvironment. Now we can free those cells up and send them into the peripheral blood where they can be killed.”

Dr. Tam further suggested that perhaps CLL should be managed more like chronic myelogenous leukemia, “with indefinite suppression of the disease with an oral agent.” Acknowledging that follow-up is still early, he concluded, “We have reached a crossroads in CLL treatment.” ■

Disclosure: Dr. Tam reported no potential conflicts of interest.

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