Welcome back to plenary session. This is Ash Update number two, the Aspen study, Xandabrutinib,

and relapse refractory CLL. I'm going to walk you through my thoughts on this. I've heard people

praise this study, the talk of the town, Xandababab defeats ibupububub, yeah, yeah, yeah, yeah. I'm going to have a

slightly different perspective. Why? Because I'm starting out reading this study is both an oncologist, someone who sees CLL patients

and knows a great deal about CLL, but also somebody's primary appointments in EPI and biostats.

And epion biostat's part of what really makes this trial important.

So we're going to analyze that aspect of it.

The other thing I'd say is off the bat.

We do need more head-to-head studies in oncology.

When novel drugs come out on the market like pharmacyclics ibup and next-in-class drugs come,

like Beijing's Xanibrutinib, it behooves us to run randomized control trials that test,

which is a better strategy to start with ibuprootinib, switch the people who are idiosyncretically

intolerant to Xanib or vice versa. But those studies need to be carefully designed. The primary

endpoint has to make sense. The study power has to make sense. It has to be fair and balanced.

And the moment the sponsor of the second company starts to play on those strings, they're likely

to bias it in their direction.

And I worry that's what happened here.

So we're going to talk about that here.

This is Brown and colleagues in England Journal of Medicine.

Let's take a look.

The consort figure, the first figure, 769 people, relapse refractory, CL, randomized one-to-one,

randomization.

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