An expert on chronic lymphocytic leukemia reviews the CLL14 trial, evaluating venetoclax plus obinutuzumab in patients with previously untreated CLL.
Case: A 72-Year-Old Woman with Newly Diagnosed Chronic Lymphocytic Leukemia (CLL)
Clinical Presentation:
Clinical Workup and Diagnosis:
Current Treatment:
Transcript:
John Allan, MD: There are several frontline treatment approaches in newly diagnosed CLL [chronic lymphocytic leukemia] that are FDA approved. In early 2023, we had some new approvals even for CLL. There are 2 standard approaches per the NCCN [National Comprehensive Cancer Network] guidelines that we think about. The first approach and the oldest, tried-and-true approach is a continuous therapy BTK [Bruton tyrosine kinase] inhibitor approach. BTK inhibitors are a class of drugs that include agents such as ibrutinib, acalabrutinib, and the most recent addition to this FDA approval is zanubrutinib, which achieved FDA approval in CLL in January of 2023. These drugs are all great. Acalabrutinib and zanubrutinib have differentiated themselves in terms of selectivity for BTK and have less off-target effects, therefore potentially fewer toxicities. That has been borne out in head-to-head clinical trials. So in a sense, in the United States the most preferred BTK [inhibitors] are these second-generation agents such as acalabrutinib or zanubrutinib. But ibrutinib is still there and is also a great agent and option.
The other approved frontline option for our patients with CLL is a venetoclax and obinutuzumab-based approach. This has gained approval based on the CLL14 study, as I alluded to. These are the 2 main therapeutic approaches. What we don’t have are head-to-head data between these 2 types of approaches available, though there are ongoing clinical trials accrued that are assessing this question. Right now, we don’t have head-to-head data to say one approach is better or whether a patient population is better for one approach. Obviously, there are pros and cons to a continuous therapy inhibitor-based approach vs a venetoclax fixed-duration–based approach. And we’ll be going through those throughout this session.
Transcript edited for clarity.
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