Our Doctors Are Excited – Maybe We Should Be Excited, Too

Dr. Neil Kay from the Mayo Clinic discusses advances in CLL treatment with Andrew Schorr at the iwCLL 2013 conference in Cologne, Germany.

Staying current on developments in cancer continues to mean a lot of travel, and more time to work on reading the biography of cancer, “The Emperor of All Maladies.” I wish I had more time for this big book, but I am always sure to read it on planes during those times when everything electronic has to be turned off.

One thing the book has educated me about is the number of the twists and turns in the fight against cancer: the wrong directions, blind alleys and great debates. It was with all that in mind that I recently attended a gathering in Cologne, Germany of chronic lymphocytic leukemia (CLL) experts from around the world – iwCLL 2013. It was very cool because of the progress they reported in beating back CLL and fascinating as they lined up on different sides of how to go forward in the short-term. The Patient Power team obtained more than 20 video interviews from the meeting which will soon be available for patients on patientpower.info and for oncology professionals at oncologytube.com/patientpower.

Our interviews with Drs. Neil Kay and Tom Kipps are already garnering high interest. I asked each expert: “Based on what you are hearing here or what you are presenting, are you encouraged for patients?” The answer was a resounding “Yes!” and most added they feel they are in the most exciting time in their hematology/oncology careers.

What are they so excited? First, they’re thrilled that promising drugs are approaching expected approval that are targeted approaches that work amazingly well for a broad number of patients of any age. Where patients had options running out or could not withstand debilitating side effects of standard approaches, these new ones may well be elegant answers. Some new medicines are oral therapies; some are infused, targeted monoclonal antibodies. These are more powerful than the options we’ve had for a few years. The excitement is heightened as trials continue to combine these medicines for even more power over the disease.

This news was layered on top of other reports that existing therapies that have been around for years, based on chemotherapy, have worked for many people and may have even cured some – myself included. Long-term data shows some patients who are more than nine years out from treatment with FCR chemotherapy (fludarabine, cyclophosphamide , rituximab) may not relapse. I am thrilled, of course. But I know many previously treated patients are not so lucky and the new medicines may be just what they need. It’s the same for patients who have not received treatment yet, but may need it soon.

Now to the debate: If FCR and BR (bendamustine, rituximab), another chemo-based regimen, works for many people, and you receive it over months and then are “done,” shouldn’t that still be an option versus ongoing pill taking and the like with one or more expensive medicines? On the other hand: Isn’t daily therapy in the form of a pill better than the side effects of chemo and the not insignificant risk of chemotherapy leading to a second cancer? While all my interviewees were “excited” about progress and their ability to help patients, they were divided about whether chemo is “dead” or should be, at least for now.

Drs. Kay and Kipps said they will have more and possibly different things to say the next time we meet, in December at the ASH (American Society of Hematology) meeting in New Orleans. It’s definitely a “moving target” but in a very positive direction. Patients who are on the cusp of treatment, and their doctors, have a lot to consider these days, as well as a lot to be excited about.