This was a lymphoproliferative session with two key speakers, really, and both mantle cell lymphoma and CLL, the UK has got very strong trials groups and research going on. The mantle cell lymphoma was presented by Simon Rule, Professor Rule from Plymouth, and he leads the mantle cell lymphoma trials in the UK and he’s done some very exciting work with some of the novel agents. So he went through the paradigm of treatment for mantle cell lymphoma, which is a very difficult to treat lymphoma, what to do with front line patients at various ages and gave us a nice algorithm of how to treat the disease and where transplant fits in and where novel agents fit in. Then he did a lot of discussion around the novel agents that have been approved and are used in mantle cell lymphoma, so ibrutinib particularly showing very promising results, and how we’re going to use those drugs going forward – a strategy of combining therapies to try and move to a more effective therapy going long-term.

Then George Follows, who is a haematologist in Cambridge and he’s the Chair of the UK CLL Forum, gave a nice presentation of the novel agents in CLL. So looking at refractory disease, looking at ibrutinib, idelalisib and the other therapies that we now have and are available in the UK, funded on the cancer drug fund, which have really made a massive difference to the outlook for patients with relapsed, refractory and poor risk CLL. Then he presented two or three cases of CLL patients, real patients, and we had a very active debate involving the faculty and also the audience to look at how we treat patients, difficult patients, what decisions we make.

What do you think we can learn from this?

What we’ve learnt and what we’re learning is we have a lot of, both for mantle cell lymphoma and for CLL, there has been a lot of work on the biology of the disease, understanding why the disease occurs, how it proliferates, the various pathways and genes that are affected. That’s led through to these novel agents. So we’re now moving, we’re well in the targeted era of therapy for mantle cell and CLL. I think the excitement is really going to be around combining these agents together and moving to strategies that eradicate detectable disease and how we can do that safely and how the UK can lead that, because of the nature of our trials set-up where patients are encouraged to go into trials and we have a single strong NCRI structure, both for indolent lymphoma, mantle cell lymphoma and for CLL.

Professor Rule, as I said, leads the mantle cell group and is looking at combinations of two or three of these agents together – ibrutinib with ABT-199 and novel antibodies such as obinutuzumab to see if they improve outcomes. Likewise in CLL we have the same paradigm shift, really, where we’re looking at combining these agents together in a sequential way in terms of one trial leading to the next and using the drugs together. Again, moving to eradicate detectable disease and hopefully improve outcomes.

What are the challenges you’re now faced with?

We’re getting familiar with the new agents; the challenge we have is now do we fit these drugs in? We have two drugs that are licensed now and funded in the UK, idela and ibrutinib, for CLL; we only really have one of them for mantle cell, ibrutinib. But in CLL how do we choose the best drug for our patients? Even now, if I look at my trials clinic, and I have a big CLL trials clinic, it has grown hugely over the last two or three, four years because these patients are now surviving, they’re on therapy and they’re being referred in for trials. That gives us the challenge, and we know it’s a nice challenge, which drug shall we use, which is the best drug for that particular patient, how do we personalise therapy to individual patients? That’s one of the major things that’s going to happen over the next two or three years.

Is there a message you would like to end on?

We’re in a time of very active development so every meeting there’s new data, new exciting data. I think the importance of clinical trials can’t be overestimated or overemphasised; we need to be considering clinical trials for our patients so we can really move these drugs forward quickly. For doctors, haematologists, managing these patients we almost need to plan a strategy for a patient. So it’s no good having one therapy and not thinking about what comes next. If you’re going to use a therapy, say FCR for CLL, what’s the strategy if the patient doesn’t respond well? What’s the next drug you’re going to use? Where does transplant fit in? Where do combinations fit in? So we need to think about the impact of our initial therapy on the future treatment of that patient going forward