First-Line Prescribing Preferences of U.S. Hematology-Oncology Physicians for Patients with CLL: Impact of Novel Agents

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4676-4676
Author(s):  
Mark R. Green ◽  
Michael E. Williams ◽  
Joanne Willey ◽  
Arden Buettner ◽  
Douglas Neely ◽  
...  
Keyword(s):  
Type Ii Diabetes ◽  
Lymphocytic Leukemia ◽  
Low Grade ◽  
Costal Margin ◽  
Audience Response ◽  
First Line ◽  
Prior Therapy ◽  
Clinical Scenarios ◽  
Additional Agent ◽  
Audience Response Technology

Abstract Background: In November, 2013 obinutuzumab (obin) was approved in combination with chlorambucil (chlor), as 1st line therapy (Rx) for patients (pts) with chronic lymphocytic leukemia (CLL). In February, 2014, ibrutinib was approved in CLL for pts who had received > 1 prior therapy. In April, 2014 ofatumumab (ofa) + chlor was approved as 1st line Rx for pts with CLL for whom fludarabine-based therapy is considered inappropriate. During 2014 we studied PPrefs of 180 U.S-based hematology-oncology physicians (HOPs) for 1stline Rx across a range of clinical scenarios varying by age, co-morbidities, and selected laboratory features. Methods: PPrefs were assessed through a validated, proprietary, live, case-based market research tool (Challenging Cases®). Assessment dates were 3/08/14 and 4/26/14. Data were acquired using blinded, audience-response technology. A core scenario (CS) and 3 variant scenarios (VS) were utilized to evoke physician PPrefs. CS: 63-year-old male; 1-2 cm diffuse adenopathy, spleen 3 cm below costal margin. Presented with recent fatigue/ low grade fevers; no relevant co-morbidities; CD 38=12%. No FISH abnormalities. PS1. VS1: All equal except 17p deletion and CD 38 = 42%; VS2: CS (age 63; no abnormal FISH) plus co-morbidities (medication-controlled hypertension, type II diabetes, and mild COPD); VS3: VS2 BUT age 73 with same co-morbidities. Results: PPrefs by scenario shown below: Abstract 4676. Table 1PPref CS VS1 VS2 VS33/8/144/26/143/8/144/26/143/8/144/26/143/8/144/26/14Bendamustine + rituximab[BR]61%63%52%51%72%68%66%64%Bendamustine + Obinutuzumab0%2%2%6%0%1%3%2%Chorambucil + Obinutuzumab1%3%2%3%2%5%8%17%FCR20%16%25%19%5%8%1%2%Ibrutinib + additional agent(s)2%3%11%16%7%8%6%7%Other2%2%4%2%2%2%3%2%Observe14%10%3%3%11%6%12%5% Conclusions: As of March-April 2014 BR is the 1st line PPref of 51% -72% of US-based HOPs across 4 plausible newly diagnosed CLL scenarios. In VS1 (age 63; 17p deletion) ibrutinib based Rx is emerging despite lack of 1st line indication. In VS 3 (age 73, multiple co-morbidities present, neither high risk FISH nor CD 38 positivity) 1st line PPref for Chlor + Obin is emerging. Prior to ASH 2014, we will assess PPrefs of approximately 180 additional HOPs related to these scenarios (with ofatumumab + chlorambucil added as a treatment option) and have aggregate PPref data (N > 350) across all of 2014 for ASH. Disclosures Williams: Pharmacyclics, Janssen: Consultancy, Research Funding.

Dexamethasone, Cytarabine and Cisplatin or Oxaliplatin Schedule (DHAP or Ox-DHA) Is Effective and Widely Applicable in Chronic Lymphocytic Leukemia and Waldenström Macroglobulinemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3434-3434
Author(s):  
Marco Ruella ◽  
Irene Ricca ◽  
Angela Gueli ◽  
Daniela Gottardi ◽  
Daniele Caracciolo ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Partial Remission ◽  
Conflicts Of Interest ◽  
Lymphocytic Leukemia ◽  
Hematological Toxicity ◽  
High Dose ◽  
Main Concern ◽  
Low Grade ◽  
First Line ◽  
Salvage Regimen

Abstract Abstract 3434 Poster Board III-322 Introduction Fludarabine alone or in combination is considered the standard treatment for Chronic Lymphocytic Leukemia (CLL). A high response rate is usually observed following fludarabine, particularly if delivered together with rituximab. In spite of the high therapeutic efficacy, most patients subsequently relapse. For these patients there are no defined salvage treatments. Moreover, fludarabine-containing regimens may have some restrictions due to non-negligible side effects. In particular, there are some concerns in employing fludarabine first-line in patients with autoimmune hemolytic anemia (AHA) or with renal function impairment. In addition, fludarabine has been reported to compromise the capacity of progenitor cell mobilization. Thus, novel effective treatment approaches are needed, for the management of patients failing after fludarabine-based regimens and for those unfit to receive fludarabine first-line. A very effective salvage regimen for refractory/relapsed lymphoproliferative disorders is the DHAP combination. DHAP has been widely used in the rescue of both low-grade and high-grade lymphoma. However, its efficacy in CLL has not been verified yet. The main concern with DHAP is the well known renal toxicity of cisplatin. However, the use of the less toxic analog Oxaliplatin, might circumvent this problem. Indeed, recent reports have shown that the inclusion of oxaliplatin into the original DHAP regimen (Ox-DHA) markedly improves the tolerability and widens regimen applicability. Aim: To evaluate retrospectively feasibility and efficacy of the DHAP and Ox-DHA regimens in CLL and in other non-follicular low-grade lymphomas, in particular in Waldenström Macroglobulinemia (WM). Patients and Methods Between 2002 and 2008, 84 low-grade lymphoma patients received DHAP or Ox-DHA; their median age was 60 yrs. (range: 24-84), 58 were male; 70 patients had CLL with advanced stage (65 patients with Binet stage B and C) and 14 had WM. Thirty-eight patients were treated at first relapse, 27 at second or subsequent relapse, whereas 19 received the DHAP or Ox-DHA schedule as first-line treatment, in place of Fludarabine, due to: i. AHA (3 patients), ii. concomitant second malignancy (4 cases), iii. need of initial debulking, before a high-dose program with autograft. The original DHAP schedule requires hospitalization for three to five days; it includes: Cisplatin 100 mg/sqm on day 1, Cytarabine 2 g/sqm/b.i.d. every 12 hrs. on day 2, Dexamethasone 40 mg days 1-4. Ox-DHA can be delivered in the outpatient setting, compared to DHAP, there are two main modifications: Oxaliplatin 100 mg/sqm in two-hr i.v. infusion on day 1, and Cytarabine 2 g/sqm two doses delivered in two consecutive days (day 2 and day 3). Rituximab (375 mg/sqm) was added in 12 DHAP and 28 Ox-DHA courses. Patients aged over 70 yrs had variable dose reductions (25% to 50%). Results Ox-DHA had hematological toxicity analogous to that commonly observed with the original DHAP schedule; 11 patients required short hospitalization for severe infectious complications; 7 patients developed fever of unknown origin, 4 showed reversible peripheral neurotoxicity. The program was discontinued in four patients due to disease progression (3 patients) and AHA (1 case). There were no severe liver or renal toxicities. No toxic deaths were recorded. The overall response (OR) rate was 90%; in details, complete remission (CR), or very good partial remission (VGPR), was achieved in 41% of patients receiving DHAP without rituximab and 50% of those receiving DHAP supplemented with rituximab. In the Ox-DHA group, 50% of patients treated without rituximab and 75% of those treated with rituximab reached CR or VGPR. Among patients treated at diagnosis, overall 47% reached CR or VGPR and 42% reached partial remission (PR). The OR rate was unexpectedly high at 91% in patients treated for refractory/relapsed disease, with 66% of them achieving CR/VGPR (74% and 55% for patients at 1st and ≥ 2nd relapse, respectively) and 35% PR. Among 14 WM patients, 1 obtained a CR, 5 a VGPR, 6 a PR and 2 had a stable disease. Conclusions Dexamethasone, Cytarabine and Cisplatin or Oxaliplatin schedule is a well tolerated regimen, highly effective both front-line and in the rescue for relapsed/refractory disease in CLL and WM patients. Future clinical trials will define the real efficacy of the DHAP or Ox-DHA regimen in the management of CLL and WM patients. Disclosures No relevant conflicts of interest to declare.

Phase II trial of fludarabine monophosphate as first-line treatment in patients with advanced follicular lymphoma: a multicenter study by the Groupe d'Etude des Lymphomes de l'Adulte.

1996 ◽  
Vol 14 (2) ◽  
pp. 514-519 ◽  
Author(s):  
P Solal-Céligny ◽  
P Brice ◽  
N Brousse ◽  
H Caspard ◽  
Y Bastion ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Progression Free Survival ◽  
Complete Response ◽  
Lymphocytic Leukemia ◽  
World Health ◽  
Low Grade ◽  
Line Treatment ◽  
First Line ◽  
Fludarabine Monophosphate ◽  
First Line Treatment

PURPOSE Fludarabine monophosphate (FAMP) is a major drug in the treatment of chronic lymphocytic leukemia and showed efficacy in selected groups of patients with low-grade lymphomas, most of them pretreated. The aim of this trial was to assess the efficacy and the toxicity of FAMP in untreated patients with follicular lymphoma. PATIENTS AND METHODS Fifty-four untreated patients with advanced follicular lymphoma were treated with intravenous (i.v.) fludarabine at a dose of 25 mg/m2/d during 5 days every 4 weeks, to a maximum of nine cycles. RESULTS The toxicity of the drug was mild, mainly granulocytic. Granulocytopenia > or = 3 (World Health Organization [WHO]) was observed during 48 of 328 cycles (14.6%) and in 22 of 53 (41%) patients assessable for toxicity. Fludarabine had to be stopped prematurely because of toxicity in nine patients: marrow toxicity in five, peripheral neuropathy in two, and interstitial pneumonitis and hepatitis in one patient each. Among 49 patients assessable for response, the overall response rate was 65% and the complete response (CR) rate 37%. The median progression-free survival interval for all patients was 13.6 months. CONCLUSION These results confirm that fludarabine is active when used as first-line treatment in patients with follicular lymphoma and has a low toxicity rate. It may be used as single treatment in elderly patients. Associations of fludarabine with other drugs active against follicular lymphoma need to be determined.

scholarly journals Characteristics of Mantle Cell Lymphoma (MCL) and Chronic Lymphocytic Leukemia (CLL) Patients Treated with Acalabrutinib in a Real World Setting in the United States

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3488-3488
Author(s):  
Kellie Ryan ◽  
Chakkarin Burudpakdee ◽  
Xiaohui Zhao ◽  
Hannah Le ◽  
Aimee Near
Keyword(s):  
High Risk ◽  
Real World ◽  
Hematologic Malignancies ◽  
Lymphocytic Leukemia ◽  
Phase Iii ◽  
First Line ◽  
The Real ◽  
Prior Therapy ◽  
Real World Setting ◽  
Phase Iii Trials

Introduction Acalabrutinib was approved by the US Food and Drug Administration on October 31, 2017 for patients with MCL who have progressed on at least one prior therapy and is currently being evaluated in phase III trials for first-line MCL, first-line CLL, and relapsed/refractory (r/r) CLL. Additionally, acalabrutinib received guideline and compendia listing for use in MCL and CLL patients. There is a lack of information on the current treatment patterns with acalabrutinib in real world clinical practice. To that end, we conducted a descriptive analysis of the use of acalabrutinib in the real-world setting for MCL and CLL patients. Methods A retrospective cohort study was conducted using IQVIA's longitudinal prescription (LRx) database linked to the medical claims (Dx) database. Patients ≥18 years old with ≥1 claim for acalabrutinib in LRx between November 1, 2017 and April 30, 2019 were identified; the first claim was index date. Patients were also required to have ≥ 1 Dx claim between November 1, 2016 and April 30, 2019, and ≥ 12 months baseline (defined as ≥ 1 LRx claim and ≥ 1 Dx claim within 12 months pre-index and > 12 months pre-index). Patients were required to have ≥2 diagnoses of either MCL or CLL before index (without diagnosis of the other cancer) to create two mutually exclusive cohorts. Patients were excluded if they had data quality issues or evidence of clinical trial enrollment during the study period. Descriptive statistics were used to summarize baseline demographic and clinical characteristics overall and stratified by prior ibrutinib use. Results were described for MCL and CLL cohorts separately. Results A total of 264 MCL and 204 CLL patients treated with acalabrutinib were identified in the study. For both cohorts, the majority (57.2% MCL / 59.3% CLL) were 70 years or older, with a median (interquartile range [IQR]) age of 71.0 (15.0), mean (standard deviation [SD]) of 70.5 (9.7) for MCL and median age of 71.5 (15.0), mean 69.9 (11.1) for CLL patients (Table 1). 76.9% of MCL and 59.8% of CLL patients were male, and over half were commercially insured (50.4% MCL / 52.5% CLL). In the 12-month pre-index period, MCL and CLL patients had a mean (SD) Charlson Comorbidity Index (CCI, excluding hematologic malignancies) of 1.6 (2.2) and 1.4 (1.8), respectively; hypertension (67.8% MCL / 67.7% CLL), other hematologic malignancies (48.9% MCL / 52.0% CLL), and infection (28.0% MCL / 31.4% CLL) were the most common comorbidities. Other common (i.e., ≥ 20%) conditions included anemia and neutropenia for the MCL cohort, and arrhythmia, fatigue/asthenia, atrial fibrillation (A-fib), anemia and thrombocytopenia for the CLL cohort. Over 60% of MCL and CLL acalabrutinib-treated patients were defined as high risk of A-Fib (Chyou, Hunter et al. 2015). In terms of prior Bruton's Tyrosine Kinase-inhibitor (BTKi) treatment, 37.9% of MCL and 64.7% of CLL patients had prior ibrutinib use. More prior ibrutinib users were defined as high risk A-Fib status at time of acalabrutinib start than patients without prior ibrutinib use, and prior ibrutinib users had a higher frequency of several comorbidities (e.g., hypertension, fatigue/asthenia; Table 1). Conclusions With the relatively recent approval, this is the first analysis of acalabrutinib use in clinical practice and description of characteristics of MCL and CLL patients being treated with this medication in the real world. Before initiating acalabrutinib, approximately one-third of MCL patients and two-thirds of CLL patients received ibrutinib (reasons for discontinuing ibrutinib were not explored). Although the overall comorbidity score was similar between patients with and without prior BTKi exposure, BTKi-naïve patients had a slightly lower frequency of high-risk A-Fib status at acalabrutinib initiation. Future studies are warranted to evaluate the treatment patterns of acalabrutinib and outcomes in the real-world setting. Disclosures Ryan: AstraZeneca: Employment, Equity Ownership. Burudpakdee:IQVIA: Consultancy. Zhao:IQVIA: Consultancy. Le:AstraZeneca: Employment, Other: Stocks. Near:IQVIA: Consultancy. OffLabel Disclosure: Acalabrutinib is an oral inhibitor of Bruton's Tyrosine Kinase. It was approved by the US Food and Drug Administration on October 31, 2017 for patients with mantle cell lymphoma (MCL) who have progressed on at least one prior therapy and is currently being evaluated in phase III trials for first-line MCL, first-line chronic lymphocytic leukemia (CLL), and relapsed/refractory CLL.

scholarly journals First-line therapy for young patients with CLL

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 146-148
Author(s):  
Nitin Jain ◽  
Susan O’Brien
Keyword(s):  
Prognostic Markers ◽  
Young Patients ◽  
Lymphocytic Leukemia ◽  
Costal Margin ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Night Sweats ◽  
History Of

Abstract A 61-year-old man with a history of chronic lymphocytic leukemia (CLL) presents with complaints of worsening fatigue and night sweats. He was diagnosed with CLL 3 years ago on routine blood count testing. He has no major medical comorbidities. On examination, he has several 2- to 3-cm lymph nodes in the cervical and axillary area. Spleen is palpable 5 cm below the costal margin. Blood counts show lymphocytosis with thrombocytopenia and anemia. Prognostic markers include deletion 13q by fluorescence in situ hybridization analysis and mutated IGHV. You are asked by the hematology fellow you are supervising about the best treatment of this patient.

2-Chlorodeoxyadenosine treatment of low-grade lymphomas.

1992 ◽  
Vol 10 (3) ◽  
pp. 371-377 ◽  
Author(s):  
A C Kay ◽  
A Saven ◽  
C J Carrera ◽  
D A Carson ◽  
D Thurston ◽  
...  
Keyword(s):  
Phase Ii ◽  
Phase Ii Trial ◽  
Single Agent ◽  
Antineoplastic Agent ◽  
Lymphocytic Leukemia ◽  
Low Grade ◽  
Significant Activity ◽  
Prior Therapy ◽  
Significant Toxicity ◽  
Duration Of Response

PURPOSE Because of the need to identify effective new agents in the treatment of non-Hodgkin's lymphoma and because of the high activity of the purine analog 2-chlorodeoxyadenosine (2-CdA) against chronic lymphocytic leukemia and hairy cell leukemia, a phase II trial of 2-CdA was initiated in patients with low-grade lymphocytic lymphomas. PATIENTS AND METHODS Forty patients with low-grade lymphocytic lymphomas including diffuse small lymphocytic, follicular small-cleaved, and follicular mixed histologies were enrolled onto the study. Conventional therapies had failed in all patients, and six patients had lymph node biopsies showing evidence of histologic evolution to a higher-grade lymphoma. A total of 107 courses of 2-CdA were administered. There were 27 males and 13 females. The median age was 59 years (range, 37 to 80 years). Patients had received a median of three prior therapies (range, one to six therapies). RESULTS An overall response rate of 43% was achieved, with eight patients experiencing complete responses (CRs) and nine patients experiencing partial responses (PRs). The duration of responses ranged from 1 to greater than 33 months without maintenance therapy (median duration of response, 5 months). Histology and prior therapy history did not seem to correlate with responses. Significant toxicity was limited to bone marrow suppression; 18% of patients developed neutropenia, and 30% developed thrombocytopenia. CONCLUSIONS This phase II trial demonstrates that 2-CdA is an effective antilymphocyte, antineoplastic agent with significant activity as a single agent in patients with recurrent or refractory low-grade lymphocytic lymphoma. Responses were achieved with an acceptable toxicity profile. Further trials of this agent in previously untreated patients and in combination regimens are indicated and will be developed.

Pentostatin, Cyclophosphamide, Rituximab, and Mitoxantrone (PCRM): A New Highly Active Regimen for Patients with Chronic Lymphocytic Leukemia (CLL) Previously Treated with PCR or FCR.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3115-3115 ◽  
Author(s):  
Nicole Lamanna ◽  
Mark L. Heaney ◽  
Renier J. Brentjens ◽  
Joseph G. Jurcic ◽  
Mark A. Weiss
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Phase 1 ◽  
Median Number ◽  
Infectious Complications ◽  
Lymphocytic Leukemia ◽  
Low Grade ◽  
Prior Therapy ◽  
Treatment Regimens ◽  
Highly Active ◽  
Purine Analogs

Combination therapy with purine analogs, alkylators, and/or monoclonal antibodies has markedly improved the quality of responses in patients with chronic lymphocytic leukemia (CLL). Most regimens have utilized fludarabine as the purine analog but the severe myelosuppression and immunosuppression of these combinations require careful attention to dosing and schedule to minimize these toxic complications. Of the purine analogs active in CLL, pentostatin is the least myelosuppressive. Previously, we reported that combination pentostatin, cyclophosphamide, and rituximab was very active and acceptably safe to administer to patients with CLL and in the salvage setting this regimen appeared to have less myelosuppression and less frequent infectious complications than comparable fludarabine-based combinations. The current study combines pentostatin 4mg/m2, cyclophosphamide 600mg/m2, rituximab 375mg/m2 (omitted from cycle 1) and mitoxantrone (dose escalated in a phase 1 portion starting at 6mg/m2, 8mg/m2, and 10mg/m2) all administered on day 1 of 28-day cycles for a total of 6 treatments. Supportive measures included prophylactic administration of pegfilgrastim, sulfamethoxazole/trimethoprim, acyclovir, and antiemetics. Renal function was closely monitored and all patients received at least 1.5 liters of intravenous hydration with the administration of chemotherapy. Twenty-one patients (median age 62, range 44–74) with CLL (17 patients) or other low grade B cell neoplasms (4 patients) have been enrolled. There were 16 men and 5 women. Of the CLL patients all had either high risk disease (71%) or “active” intermediate (29%) risk disease and their median pretreatment WBC count was 74,000/μl, HGB 9.9 g/dl, and PLT 144,000/μl. The median β-2 microglobulin was 3.3 mg/l. The median number of prior treatment regimens was two (range 1–6). Most of the CLL patients (65%) had previously been treated with chemoimmunotherapy utilizing PCR or FCR. Response data is currently available for 16/17 of the CLL patients. In this group there were 15 responses (94%), including 4 CRs (25%) and 11 PRs (69%). Prior therapy with PCR or FCR did not adversely affect the frequency of response with 91% of these patients responding (CR in 19% and PRs in 73%). These preliminary results indicate that PCRM therapy is very active and well tolerated even in patients who have previously received FCR or PCR.

Prescribing preferences of U.S. oncologists for patients (Pts) with metastatic urothelial carcinoma (mUC) at first recurrence: Impact of novel agents.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 365-365
Author(s):  
Maria L. Lankford ◽  
Joanne P. Willey ◽  
Arden Buettner ◽  
Susan Lynne Britton ◽  
Mitch Scharf ◽  
...  
Keyword(s):  
Market Research ◽  
Locally Advanced ◽  
Audience Response ◽  
Muscle Invasive Bladder Cancer ◽  
Medical Need ◽  
Clinical Scenarios ◽  
Metastatic Urothelial Carcinoma ◽  
First Recurrence ◽  
Muscle Invasive ◽  
Audience Response Technology

365 Background: In May 2016 atezolizumab (A) was approved for the treatment of pts with locally advanced or mUC who have disease progression during or following platinum-containing chemotherapy (PCCT), or within 12 months (mos) of neoadjuvant or adjuvant treatment with PCCT. We evaluated prescribing preferences (PPrefs) of 248 U.S-based oncologists for 1strecurrence treatment across a range of clinical scenarios prior to and following A approval. Methods: PPrefs were assessed through a validated, case-based market research tool (Challenging Cases). Assessment dates were 3/5 and 4/30 (PRE-) and 8/6 (POST-approval). Data were acquired using blinded, audience-response technology. A core scenario (CS) and 5 variant scenarios (V1, 2, 3, 4, 5) were utilized. CS: 69-year-old pt with muscle invasive bladder cancer, with a CrCl 62 ml/min, Hgb 12.5, and PS 1, recurs in the liver and bone 18 months after receiving neoadjuvant gemcitabine/cisplatin and a radical cystectomy. V1: Same as CS but with reduced CrCl 48 ml/min. V2: Same as CS but recurrence at 6 months. V3: Same as V2 but multiple comorbidities and PS 2. V4: Same as CS but age 79. V5: Same as V4 but multiple comorbidities. The same query was posed in each setting: What therapy would you choose? Results: See Table. Conclusions: Following the approval of A, overall PPref of most regimens offered decreased across nearly all 1st recurrence scenarios in favor of A. This is particularly stark in platinum unfit (older, comorbid, poor PS) pts. This highlights the previously unmet medical need in the PCCT pre-treated mUC pts. [Table: see text]

scholarly journals Ibrutinib Could Suppress CA-125 in Ovarian Cancer: A Hypothesis

2020 ◽  
Vol 11 (1) ◽  
pp. 222
Author(s):  
Julian Matthias Metzler ◽  
Daniel Fink ◽  
Patrick Imesch
Keyword(s):  
Ovarian Cancer ◽  
Drug Effect ◽  
Mechanistic Model ◽  
B Cell Development ◽  
Lymphocytic Leukemia ◽  
Ca 125 ◽  
Low Grade ◽  
Hematological Diseases ◽  
Molecule Inhibitor ◽  
Target Effects

Ibrutinib is a small-molecule inhibitor of Bruton’s tyrosine kinase, an enzyme central in B cell development. It is indicated as a therapy for certain hematological diseases such as chronic lymphocytic leukemia (CLL), but also exerts off-target effects on several receptors and kinases. In this paper, we hypothesize that ibrutinib may suppress the tumor marker CA-125 in ovarian cancer. The hypothesis is based on an observation of CA-125 normalization in a patient with low-grade serous ovarian cancer who received ibrutinib for concurrent CLL. We propose a mechanistic model explaining this possible drug effect as a foundation for further research.

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