(Adnkronos) - “La leucemia linfatica cronica è una patologia tipica dell'anziano, per cui ci sono anche delle problematiche di trattamento, legate al fatto che spesso i pazienti molto anziani hanno anche delle comorbidità e quindi il trattamento e l'approccio terapeutico è molto più difficoltoso”. Lo afferma Alessandra Tedeschi, specialista ematologo struttura complessa di Ematologia Asst Grande ospedale metropolitano Niguarda di Milano, in occasione della conferenza stampa di AstraZeneca dedicata alla presentazione dei risultati dello studio clinico di fase III Amplify, sull’impiego di acalabrutinib e venetoclax come primo regime completamente orale a durata fissa di un inibitore della tirosin-chinasi di Bruton di seconda generazione nel trattamento di prima linea della leucemia linfatica cronica.
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00:00Leucemia lymphatica chronica is a neoplasia, a blood tumor, it is characterized by the fact
00:11that the tumoral disorder hits cells that are already immature cells, so they are not
00:17immature cells, it is not an aggressive form and hence the definition of chronic lymphatic
00:23chronic. Often the encounter is absolutely occasional, the patient realizes only because
00:31he has blood tests, high lymphocytes, rarely is symptomatic at birth. There will be a
00:36part of the patients who are never treated for this pathology, while a part of the
00:41patients will need treatment for various reasons, such as insurgency of increase
00:48in the volume of the joints, amyloid discomposition, anemia, pyasthenia. At that time the patient
00:54must be treated. Let's say that it is a typical pathology of the elderly, so I suggest that there are
01:00also problems of treatment due to the fact that often very old patients also have
01:06comorbidities and therefore the treatment, the therapeutic approach is much more difficult.
01:12Over the years we have had changes in the paradigm of therapy of chronic lymphatic
01:16chronic. Once it was treated only with immunotherapy, now we are absolutely using inhibitors,
01:23the LBTK inhibitors first, which are drugs that are given continuously when
01:29administered in monotherapy. Venetoclax has allowed us to obtain deeper responses,
01:34so we have used it in combination with monoclonal antibodies, in order to give a
01:40long-term therapy, because in any case the long-term therapy is better for the patient, it has free-of-progression
01:46survival and free-of-prolonged treatment, and therefore we have moved on to using the
01:53combinations of LBTK inhibitors with Venetoclax, which are the best therapies we have for
02:00patients at the moment. This study, which was presented this year at the ASCH, and which
02:06also received the award for being one of the best studies presented at the ASCH, is an important study
02:12because it is a randomized study. Randomized studies are fundamental for us, but also include many patients,
02:18so this is important to have absolutely consistent data. It provided for the randomization of patients
02:26with chronic lymphatic leukemia, never previously treated, therefore virgin in treatment, in three different arms.
02:34Akalavrutinib Venetoclax, therefore a second-generation LBTK inhibitor, in association with Venetoclax.
02:40Akalavrutinib Venetoclax Ovinotuzumab, compared to immunochemotherapy, which at the time the study was designed,
02:46was the treatment standard. The study has shown that the arms we have with Akalavrutinib Venetoclax
02:54have better free-of-progression survival compared to immunochemotherapy,
03:00even free-of-progression survival has been achieved with immunochemotherapy,
03:06while three years ago with Akalavrutinib Venetoclax it was 77%, 83% when we also combine the monoclonal antibody.
03:16This is seen above all in patients at the highest risk, with non-mutated immunoglobulin characteristics
03:22at the surface level, who have a slightly happier disease, let's say, in quotation marks,
03:26compared to mutated patients, and it is a bit premature to talk about survival,
03:32but we also have a better survival of Akalavrutinib Venetoclax compared to immunochemotherapy.
03:38All this, evidently, the effectiveness must be associated with excellent tolerability,
03:44and let's say that the tolerability has been very good, we have not had any unexpected problems
03:50in this therapeutic regime, so an excellent fixed-duration therapy for our patients
03:58that will probably change the therapeutic paradigm again when the combination is approved.