Clinical Cases in Chronic Lymphocytic Leukemia - Episode 19

Additional Insights: Treatment Regimens in CLL


Kristen Battiato, AGNP-C:Since my career began in 2006, I've seen a switch from the use of cytotoxic chemotherapy agents such as FCR [fludarabine, cyclophosphamide, rituximab] and BR [bendamustine, rituximab] to the use of targeted novel agents such as ibrutinib, and venetoclax, and most recently, acalabrutinib. Patients are tolerating these therapies better and they're living longer on them.

I manage the care of patients diagnosed with CLL [chronic lymphocytic leukemia] who are either on observation, or on therapies, including clinical trials. I’m able to diagnose and treat conditions. A huge part of my role as an APP [advanced practice provider] is patient education, helping patients understand the disease process and help treat adverse effects related to the disease and therapies that they’re undergoing.

Regimens most frequently used in the frontline setting with patients diagnosed with CLL include ibrutinib monotherapy; venetoclax, obinutuzumab following the CLL14 trial; and most recently, acalabrutinib is available to be used in the frontline setting. For patients who are relapsed or refractory, the treatment options depend on what they’ve previously been treated with. If they’ve seen a chemotherapy regimen such as BR [bendamustine, rituximab] or FCR [fludarabine, cyclophosphamide, rituximab], we have the option of using ibrutinib monotherapy and venetoclax, plus or minus a monoclonal antibody.

The RESONATE-3 trial compares the use of ibrutinib to ofatumumab in patients diagnosed with CLL in the relapsed/refractory setting. The trial basically showed that ibrutinib is far superior to ofatumumab, and that with prolonged therapy patients were able to achieve a deep and durable response on ibrutinib. However, there is a small population of patients on ibrutinib who were intolerant and had to come off the drug.

In addition to venetoclax and ibrutinib, you also have the option of using a PI3K inhibitor, such as such idelalisib or duvelisib.

In the past, we’ve referred our patients to the Leukemia & Lymphoma Society. They have been really helpful with both patient education and financial assistance. In addition, our pharmacy staff has access to a lot of individualized patient assistance programs, which can help mitigate the cost with ibrutinib therapy, so they’ve been really helpful as well in the past.

The You&i program can be utilized once ibrutinib is prescribed. It’ll help the patients understand their insurance coverage, potential out-of-pocket cost, and help utilize potential co-pay assistance programs that may help mitigate the cost. The You&i program will actually reach out to your insurance company to help you better understand your coverage and see if you’re eligible for those co-pay assistance programs.

Transcript edited for clarity.