Optimizing Treatment Strategies for Patients with CLL

Panelist discusses how frontline CLL treatment has evolved from choosing between continuous oral therapy vs fixed-duration combination therapy to now including new all-oral fixed-duration regimens, explaining the advantages and disadvantages of each approach based on patient preferences.

Panelist discusses how patient preference significantly impacts treatment selection and describes the process of involving patients in treatment decisions while considering disease characteristics, cytogenetics, and the fact that higher-risk patients may fare better with specific regimens.

Panelist discusses how the SEQUOIA study demonstrated that zanubrutinib monotherapy maintains excellent progression-free survival in patients with high-risk chronic lymphocytic leukemia with TP53 mutation or 17p deletion, providing a valuable treatment option for this difficult-to-treat population.

Panelist discusses how efficacy and safety data from trials like ELEVATE-TN and CLL14 inform treatment decisions, noting that while both regimens are effective, patients with 17p deletion tend to respond better to Bruton tyrosine kinase inhibitors than fixed duration venetoclax combinations.

Panelist discusses how minimal residual disease testing serves as an important tool for guiding treatment decisions in fixed-duration therapy, though standardization of testing methods and interpretation remains challenging in real-world practice.

Panelist discusses how managing toxicities requires understanding different safety profiles of novel agents, considering long-term effects like infection risk and secondary malignancies, and selecting therapies based on individual patient comorbidities and quality of life factors.

Panelist discusses how new all-oral combination regimens are transforming the treatment landscape by addressing unmet needs in patients with high-risk chronic lymphocytic leukemia, particularly those with TP53 mutations and 17p deletions, while considering factors like cost, adverse effects, and patient-specific characteristics.

Panelist discusses how Bruton tyrosine kinase inhibitors fit into real-world practice with community physicians often using monotherapy, while emphasizing the importance of specialist knowledge to optimize combination therapy selection and considering infection risks in different treatment eras.

Panelist discusses how recent ASCO updates, particularly the SEQUOIA study results, highlight the long-term efficacy of zanubrutinib in high-risk patients and represent the most significant advances in CLL treatment from the meeting.