Fludarabine
Fludarabine is a chemotherapy infusion for chronic lymphocytic leukaemia. It anchored the FCR regimen that was the first to give long remissions, and today it is used above all to prepare patients for CAR-T cells and transplants.
Overview
Fludarabine phosphate was approved in 1991 for B-cell CLL that has not responded to, or has progressed during, at least one alkylating-agent regimen, on single-arm studies from MD Anderson and SWOG. Its lasting importance is in combinations: fludarabine, cyclophosphamide and rituximab (FCR; CLL8) was the first regimen to improve overall survival in CLL and remains an option for fit patients with mutated IGHV, while fludarabine plus cyclophosphamide is the standard lymphodepletion before every approved CAR-T product and part of reduced-intensity conditioning for allogeneic transplant. Prolonged T-cell depletion brings opportunistic infection, and autoimmune haemolysis is a class hazard; neurotoxicity occurs at high doses.
- AmivantamabApproved
- CamizestrantApproved
- Comprehensive genomic profilingStandard of care
- Liquid biopsy (ctDNA)Standard of care
- LorlatinibApproved
- MRD / molecular residual disease testingEstablished
- ADC payload neutralisersPhase 1
- BGB-16673Phase 3
- Bispecific ADCPhase 3
- BRUIN CLL-321Positive
- CaDAnCe-304Recruiting
- CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)Active
- A clone report from blood at every treatment cycle
- A fast route to the matched drug when it is licensed for another cancer
- A multi-cancer platform trial of adaptive (dose-holiday) therapy
- A national rapid research autopsy network for end-stage cancer
- A standard evolvability score for every tumour
- A standing platform trial that assigns treatment by how the tumour escaped
Background: ADC sequencing, Antigen escape (antigen loss, lineage switch), BCG-unresponsive, Castration-resistant prostate cancer (CRPC), Circulating tumour DNA (ctDNA). Also on OnCo: Resistance atlas: how tumours escape and what closes the route · Lines of therapy.
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 1991 | B-cell chronic lymphocytic leukaemia after at least one alkylating-agent regimen |
Trials
topRecruiting now (live from ClinicalTrials.gov)
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Latest papers
topQuery for this drug: (TITLE:"Fludarabine" OR ABSTRACT:"Fludarabine" OR TITLE:"Fludara" OR ABSTRACT:"Fludara" OR TITLE:"historic" OR ABSTRACT:"historic") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Fludarabine, not a curated reading list.
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