Selecting Therapy for Patients With CLL

Sameer Parikh, MBBS:Treatment for chronic lymphocytic leukemia [CLL] in the frontline setting has evolved considerably in the past few years. I’m increasingly finding that a new patient consultation for 1 hour is simply not enough time to go over all of the options.

Whenever possible, I try to encourage my patients to sign up for a clinical trial, because that is the best way to get treated. Certainly, these clinical trials have to be reasonable. They need to make sense with where the patient’s disease process is.

Currently, the 2 upfront clinical trials that I offer to all of my patients are the ECOG [Eastern Cooperative Oncology Group] frontline trial and the Alliance [for Clinical Trials in Oncology] frontline trial for young and elderly CLL patients, respectively. These trials are answering important questions regarding whether time-limited therapy with a combination of ibrutinib, venetoclax, and obinutuzumab is better than ibrutinib and obinutuzumab alone. If the patient is unwilling or is unable to participate in the clinical trial, then there is a litany of options available for us to discuss, including chemotherapy, small-molecule inhibitors such as ibrutinib, the newly approved BTK [Bruton tyrosine kinase] inhibitor called acalabrutinib, or the BCL2 antagonist called venetoclax.

The choice of treatment depends on a number of factors, including the patient’s risk profile, what theirIGVH-mutation status is, what their CLL FISH [fluorescence in situ hybridization] profile shows, and what the patient’s comorbidities are.

Finally, whether patients would prefer chemotherapy versus indefinite therapy versus a fixed duration of oral therapy are all considerations that we need to discuss prior to starting therapy for our patients with newly diagnosed chronic lymphocytic leukemia.

Transcript edited for clarity.