Conversations Between Patient and Oncologist Are Important in Avoiding 'Common Mistake' When Treating CLL
In an interview with CURE®, Dr. Mazyar Shadman discussed the enormous variety of treatment preferences among patients with CLL and said that emphasis should be placed on treating each person according to their wishes.
BY Ryan McDonald and Dr. Mazyar Shadman
PUBLISHED June 27, 2020
A common mistake that tends to occur when patients are treated for chronic lymphocytic leukemia is the notion that only a patient’s cells are being treated, according to Dr. Mazyar Shadman.
In an interview with CURE®, Shadman, of Seattle Cancer Care Alliance and Fred Hutchinson Cancer Center, discussed the enormous variety in treatment preference among patients with CLL and said that emphasis should be placed on treating each person according to their wishes.
The main bulk of my discussion is really what they want. You will be surprised at how different patients are in terms of what's important for them. One side of the spectrum, I have patients who really don't want a treatment that's forever, and that makes sense, right? No matter how safe the drug is, no matter how disease-free you are, just for some patients, just the thought of being on medication forever that's for cancer is important. And they just don't want it; they want to be disease-free, but also treatment-free as long as possible. And so that's important for some patients, and in the appropriate setting, if I feel that, yes, you know, we can go with either chemotherapy-based therapy in this patient or now venetoclax-based therapy (which) is a non-chemotherapy and a time-limited option potentially. For those patients based on that decision, of course, that's what I will provide to them.
I also have patients who really don't (care, and will say) “I'm taking four medications for years, four different products, and (if) you give me something, I don't want to deal with the whole rampup and checking MRD, (but) as long as I'm fine,, I'll take it,” so that you see both sides, and you do see patients who still come for chemotherapy. So, yes, patient preference is important. Patients need to understand and need to be educated on what to expect. It's always easy to start treatment. We get patients who come back six months, seven months later, and (say) “You know what, I'm taking this for seven months it works, but can I stop? I mean, what do you mean (this) is going to go forever? The doctor who started didn't talk to me about (that).”
So, I think those conversations are actually very important. And I add one more thing, they're important because we don't have a head-to-head trial that tells me that acalabrutinib or venetoclax — which one is better. If I have that, then I probably won't give that option, or if I do, I make sure they understand that they're going for a treatment that's not superior, but we don't have that. So really, you have to sit and present both treatments and pros and cons and have them decide based on what's the best fit for them. And that's why it's important to have really a comprehensive approach to the patient … I mean, it's really treating a patient, not the molecular kind of finding in the CLL cell, and that's a common mistake: “Oh, I have somebody with a mutated (gene, and) that (means) I give chemo.” No: You have a patient who has CLL whose CLL has this (mutation). So, then you kind of look at the patient and not the other factors.