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Selecting Patients for Treatment With Ibrutinib in CLL

Jacqueline C. Barrientos, MD
Published Online:8:33 PM, Fri April 13, 2018

Jacqueline C. Barrientos, MD, associate professor of the Karches Center for Oncology Research at the Feinstein Institute for Medical Research, discusses which types of patients with chronic lymphocytic leukemia (CLL) are the best candidates for treatment with ibrutinib (Imbruvica). 

Barrientos recommends that younger patients with CLL should receive ibrutinib as part of a combination regimen to help them achieve an earlier and more complete response. On the other hand, she suggests that older patients (over the age of 65 years) should receive ibrutinib monotherapy, as it is a continuous treatment. 

Although patients with high-risk CLL have demonstrated encouraging responses from treatment with ibrutinib, these patients may benefit more from an ibrutinib-based combination regimen in the hopes that they could eventually stop receiving treatment. For example, patients with a 17p deletion are more likely to have an earlier relapse than patients with other high-risk cytogenetics while receiving treatment with ibrutinib. A combination approach could help to delay the patient’s relapse, and Barrientos highlights that there are a number of ongoing clinical trials investigating ibrutinib as a part of a combination regimen for high-risk patients. 

Patients with recent bleeding events, such as after an operation, she says, may not make good candidates for treatment with ibrutinib, whether as a monotherapy or in a combination regimen, and instead Barrientos suggests that these patients should treatment with another agent that would not pose as great a risk to them, such as venetoclax (Venclexta).
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