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Alert Number 155
Date: March 19, 2024
Drug combinations are all the rage in CLL, sometimes the alphabet strings can get pretty long (as in CFAR, RFCM, etc.). The logic seems to be to give each drug at a dose just below it “maximum tolerated dose”, but add enough different drugs to the cocktail that the cancer cells are killed before the patient is. We hope.
That brings up an important question for patients: in the surreal world of cancer math, is 1 + 1 = less than 2, sometimes?
An excellent and detailed phase-3, multi-center, randomized clinical trial conducted in Germany gives us one piece of the puzzle. It compares the combination of F + C (fludarabine + cyclophosphamide) with single agent fludarabine. Truly, this report is worth its weight in gold. Several hundred patients participated in this trial and their generosity makes it a bit easier for us to make therapy decisions. This definitive F+C versus F comparison is also useful in the sense that (with a little extrapolation on our part) it may shed light on another important comparison: R+F+C versus R+F. These two chemo-immunotherapy combinations, the first pioneered at M. D. Anderson and the second at Ohio State, are the two Top Gun award candidates right now. Which is better? Which gives you better bang for the buck?
Read our detailed analysis of the German clinical trial results in F+C versus F. Some of the results may surprise you.
Be well,
Chaya
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