Chronic Lymphocytic Leukemia with Steven Coutre, MD Case 1 - Episode 4

Ibrutinib in Older Patients with Newly-Diagnosed CLL

Steven Coutre, MD:We often treat older patients with ibrutinib. We’ve certainly treated them in the context of the trials, and we’ve treated those patients with commercially available ibrutinib now that it’s approved as frontline therapy. A very typical patient would be one that I saw last week; for example, a 78-year-old woman who I had been following for a number of years who presented initially with an asymptomatic lymphocytosis and over the years has had some increase in her lymphocyte count. She’s developed some adenopathy, as well as anemia, and now it’s gotten to the point where she’s significantly anemic and it’s impacting her quality of life. She’s symptomatic, so she really meets the standard need for treatment. She made it very clear that she’s not interested in losing her hair, and she also didn’t like the idea of chemotherapy.

It’s a good example of really looking at your individual patient and then deciding what your goal is. What do you want to accomplish when you’re choosing a treatment in this particular patient? It’s not just a one-size-fits-all. It’s not that I treat everyone with this regimen as initial treatment. You always look at your options and then make a decision. For her, it was rather easy. We have an oral therapy that’s approved and well tolerated. We know it’s going to work, and we use that option. Really reassure the patient that not only are we going to see a response, and she is going to feel better because we’re effectively treating the disease, but she’s likely to tolerate it very well.

Steven Coutre, MD, shares insights into his approach to frontline therapy for chronic lymphocytic leukemia