Future Directions for the CLL Space

Carolyn Owen, MD, associate professor in the Division of Hematology & Hematological Malignancies, University of Calgary, and hematologist at the Tom Baker Cancer Center, discusses emerging and exciting data in the chronic lymphocytic leukemia space.

In the CLL field, the introduction of ibrutinib (Imbruvica) changed the treatment paradigm. Now, experts have their choice of treatments, including Bruton tyrosine kinase (BTK) inhibitors, PI3K inhibitors, B-cell lymphoma 2 inhibitors. These agents include acalabrutinib (Calquence), zanubrutinib (Brukinsa), venetoclax (Venclexta) and more.

Additional agents are being investigated in ongoing studies and early and encouraging data have already been reported in some newer studies. Investigators are currently evaluating combination therapies, chimeric antigen receptor (CAR) T-cell therapies, pirtobrutinib (L0X0-305), a non covalent BTK inhibitor, and more.

Owen notes that she is excited to see how findings from the phase 3 GLOW trial (NCT03462719) of elderly or unfit patients with CLL who were treated with fixed-duration ibrutinib plus venetoclax in the frontline fits into the space moving forward as this combination led to deeper and prolonged undetectable minimal residual disease responses compared with chlorambucil and obinutuzumab (Gazyva).

Transcription:

0:08 | I'm most excited to see the comparison of this novel, oral combination against another novel, frontline, fixed duration combination, but that's not what this study will give us. I think we need a lot more time to decide exactly where [ibrutinib and venetoclax] fits into the treatment landscape. I think it is a very effective therapy and I think many patients will be very motivated to receive it, but I think it is difficult when new therapy is justified by clinical trial and the comparator isn't the one we would have wished was the comparator of the day. Like many different new therapies, I think we need a bit more time to figure out who is the best patient to receive this therapy and how we will recommend it compared with the other therapies that are available now, which are better than the comparator that was included in the clinical trial.