Discussing First-Line Treatments for Patients With CLL

Carolyn Owen, MD, associate professor in the Division of Hematology & Hematological Malignancies, University of Calgary, and hematologist at the Tom Baker Cancer Center, discusses how the treatment landscape has shifted in chronic lymphocytic leukemia (CLL).

Just 10 years ago, the standard of care for CLL was chemoimmunotherapy. Chlorambucil (leukeran) and obinutuzumab (Gazyva) was a treatment for older patients or those with comorbidities, and fludarabine, cyclophosphamide and rituximab (Rituxan; FCR) was the treatment for the very young or more fit patients.

In 2014 with FDA’s accelerated approval of ibrutinib (Imbruvica) options started to increase for patients with CLL. Now new novel agents in the frontline are being developed to further improve patient outcomes.

Transcription:

0:08 | Historically, the first-line treatment for CLL was very much divided based on fitness. That's becoming less and less an issue given the entry of novel agents into the frontline treatment landscape where fitness of the patient is less important because the novel agents are much more tolerable than traditional chemoimmunotherapy. Until fairly recently, chlorambucil/obinutuzumab was a treatment for the unfit, not sort of sturdy patient, often very elderly patients or those with comorbidities.

0:39 | FCR was the treatment for the very young and fit and then many therapies in between like bendamustine and rituximab can be considered against chemoimmunotherapy still in that realm. Ibrutinib monotherapy and other BTK inhibitors have moved into the frontline space. They work very well, they're usually tolerable, but unfortunately, they are sort of continuous therapies. This is a new move towards trying to include novel agents frontline, but in a fixed duration.