Current Regimens Being Investigated in Chronic Lymphocytic Leukemia

Alexey V. Danilov, MD, PhD, associate professor of medicine at the Oregon Health & Science University, discusses important studies in the chronic lymphocytic leukemia (CLL) space and questions whether combination or sequential therapy is better for patients with CLL.

Danilov says that in this new era of medicine, chemotherapy will be used less, and now the question at hand is whether patients with CLL can achieve deep responses on regimens with finite durations. At the 2019 American Society of Hematology (ASH) Annual Meeting, studies of ibrutinib (Imbruvica) plus venetoclax (Venclexta), and acalabrutinib (Calquence) plus venetoclax, with or without a CD20 antibody, were exhibited.

The AVO study of acalabrutinib, venetoclax, and obinutuzumab (Gazyva) was presented by Benjamin L. Lampson, MD, PhD, and Matthew S. Davids, MD. It demonstrated good efficacy through high response rates and high durability in patients with CLL. There were a percentage of patients with bone marrow minimal residual disease after 6 months, according to Danilov. Nitin Jain, MD, presented patients with treatment naïve CLL who showed high response rates with ibrutinib and venetoclax at ASH.

Danilov wonders if combination therapy is necessary for all patients with CLL or if combination therapy with novel agents can result in prolonged progression-free survival or overall survival compared to single-agent therapy. Longer follow-up is required for combination regimens in clinical trials to determine if physicians should use combination therapy versus sequential therapy.

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