Dr Jeff Sharman on Using Precision Medicine to Treat CLL

Jeff Sharman, MD, medical oncologist, Willamette Valley Cancer Institute and Research Center; medical director, The US Oncology Network, explains how personalized medicine has changed the way physicians think about treatment for patients with chronic lymphocytic leukemia (CLL).


How has the era of personalized medicine changed the way you think about treatment for patients with CLL?
Personalized medicine is a complex topic because what it generally refers to is a notion that you might find some feature or marker that’s unique to a patient and then select therapy on the basis of that marker. In the case of CLL, the disease is divided primarily into 2 groups of patients: those who has what’s called a mutated B-cell receptor, and those who have an unmutated B-cell receptor.

In this case, mutation is good. It means you tend to have a slower growing disease, fewer high-risk genetic markers for chemotherapy resistance, and so forth. So, by looking at the IGHV [Immunoglobulin Heavy Chain Variable] mutation, or the B-cell receptor mutation status, those patients who have mutated disease are generally those patients who are going to benefit from a chemoimmunotherapy approach, whereas the patients who are unmutated are going to clearly benefit more from the novel targeted agent approach.

I think that there is debate, frank debate within the field, even amongst those who know the disease best, as to whether or not those patients with the mutated disease should get ibrutinib or chemoimmunotherapy, and I think that in a lot of cases, that would be subject to patient preference.
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