Chronic Lymphocytic Leukaemia: KOL Insight [2018]

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Publication Date:
August 2018
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How will targeted therapy combinations transform the treatment of CLL?

Chemoimmunotherapy regimens incorporating Rituxan/MabThera have traditionally been the cornerstone of CLL treatment. How is this expected to change? With Imbruvica, Venclexta/Venclyxto, as well as biosimilar rituximab shaping the market, how do key opinion leaders (KOLs) see the treatment algorithm evolving? Will targeted therapy combinations be able to match the efficacy of conventional regimens and become the new standards of care? Novel drugs acalabrutinib, umbralisib, ublituximab, and zanubrutinib are in late-stage development but what are the most important factors resulting in utilisation of these novel agents?  Learn how KOLs see the market evolving, and how they expect developers to differentiate their pipeline therapies in KOL Insight: Chronic Lymphocytic Leukaemia (CLL).

Twelve US and European KOLs provide their candid insights on seven marketed products and six Phase III pipeline programmes.

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Top takeaways

  • Rituxan/MabThera remains entrenched in CLL treatment, but is this set to continue? Will Roche’s anti-CD20 franchise, including Rituxan/MabThera and Gazyva/Gazyvaro, preserve their market share in a competitive landscape shifting towards oral targeted drugs?
  • How is Imbruvica currently prescribed and will it continue to dominate the market? What are KOL opinions on Phase III trials examining Imbruvica in combination with either Rituxan or Gazyva/Gazyvaro?
  • Is Venclexta/Venclyxto likely to become a key player? Find out how KOLs are prescribing this drug, what concerns they have, and what factors could be addressed to encourage increased usage?
  • How do KOLs perceive acalabrutinib? Find out what KOLs think of Acerta/AstraZeneca’s acalabrutinib, and whether the drug could compete with Imbruvica.
  • How do experts view PI3 kinase inhibitors as future treatments in CLL? Two PI3 kinase inhibitors are in the pipeline (Verastem’s duvelisib and TG Therapeutics’ umbralisib (TGR-1202), but which one are KOLs most excited about?
  • What other early-stage pipeline programmes are oncologists particularly excited about? Anti-CD19 CAR-T therapies have been game-changing in other haematologic malignancies but will the same hold true for CLL?
  • How will CLL treatment practices change in the future? Will combination therapy become more frequent, and will minimal residual disease (MRD) negativity become a target for all CLL patients?
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“I am using it [rituximab] with any type of chemotherapy. Whenever we treat a patient with chemotherapy, chlorambucil or fludarabine, cyclophosphamide or bendamustine, it is always associated with rituximab.”
EU Key Opinion Leader

“AstraZeneca were smart when they designed this randomised Phase III trial, head-to-head against ibrutinib, because the best way to get usage of their drug, acalabrutinib is to actually show an improved safety profile and at least comparable efficacy in that head-to-head trial.” 
US Key Opinion Leader

Sample of therapies covered

Marketed Therapies

  • Rituxan/MabThera (rituximab; Roche)
  • Rituximab biosimilars (various companies such as Celltrion, Sandoz, Napp, MundiPharma)
  • Gazyva/Gazyvaro (obinutuzumab; Roche)
  • Arzerra (ofatumumab; Novartis)
  • Imbruvica (ibrutinib; Janssen Biotech/AbbVie)
  • Zydelig (idelalisib; Gilead)
  • Venclexta/Venclyxto (venetoclax; AbbVie/Roche)

Pipeline Therapies

  • duvelisib (Verastem)
  • acalabrutinib (Acerta Pharmaceuticals/AstraZeneca)
  • umbralisib (TGR-1202; TG Therapeutics)
  • ublituximab (TG Therapeutics)
  • zanubrutinib (BeiGene)
  • Revlimid (lenalidomide; Celgene)

KOLs interviewed

KOLs from North America

  • Prof. Thomas Froehlich, MD, MSHA; Professor of Medicine, Interim Division Chief, Hematology-Oncology and Medical Director at Harold C. Simmons Comprehensive Cancer Center, UT Southwestern, Dallas, USA
  • Dr. Chaitra Ujjani, MD; Hematologist in Washington, District of Columbia, affiliated with MedStar Georgetown University Hospital, Washington DC, USA
  • Prof. Bruce D Cheson, MD; Deputy Chief Division of Hematology and Oncology, Head of Hematology, Professor of Medicine at Georgetown University Medical Center, Washington DC, USA
  • Dr. Jeff Sharman, MD; Medical Oncologist at the Willamette Valley Cancer Institute and Research Center and Medical Director of Hematology Research at The US Oncology Network, USA
  • Prof. Steven Coutre, MD; Professor of Medicine (Hematology) at the Stanford University Medical Center, USA
  • Dr. Matthew Davids, MD; Assistant Professor, Medicine, Harvard Medical School. Attending Physician, Lymphoma Group, Medical Oncology - Division of Hematologic Malignancies, Dana-Farber Cancer Institute, USA

KOLs from Europe

  • Dr. Raquel de Paz, MD; Associate Professor of Medicine at the Universitat Autònoma de Madrid and Haemato-oncologist at the Hospital La Paz Institute for Health Research, Madrid, Spain
  • Prof. Christopher Fegan, MB, MD, FRCP, FRCPath; Director and Consultant Haematologist, School of Medicine Cardiff, Wales, UK
  • Dr. Nicolas Blin, MD; Haemato-oncologist at the Centre Hospitalier de Nantes, Nantes, France
  • Anonymous KOL, Germany; Professor at the Department of Haematology at a leading university in Germany
  • Anonymous KOL, Germany; Professor and Medical Director at a leading university in Germany
  • Anonymous KOL, Italy; based at a leading private university in Italy

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