Dr. Davids Discusses Frontline Approaches in CLL

Matthew S. Davids, MD, MMSc, associate director, CLL Center, Dana-Farber Cancer Institute, assistant professor of medicine, Harvard Medical School, discusses frontline treatment approaches for patients with chronic lymphocytic leukemia (CLL).

There are several effective options available for patients in this setting, Davids says. Historically, patients were treated with chemoimmunotherapy-based regimens, but newer drugs such as the BTK inhibitor ibrutinib (Imbruvica) and the BCL2 inhibitor venetoclax (Venclexta) are coming through the pipeline. An important treatment-driving factor is whether or not the patient has deletion 17p. If patients have this high-risk marker, physicians are more likely to use a novel, ibrutinib-based treatment approach, Davids says.

If patients have lower-risk disease—particularly IGHV mutations—traditional chemoimmunotherapy regimens are still the standard of care. For young, fit patients, the triplet of fludarabine, cyclophosphamide, and rituximab (Rituxan; FCR) could even have curative potential. For the patients who are somewhere in the middle of high risk and good prognosis, physicians should consider several individual factors to decide between FCR and venetoclax- or ibrutinib-based regimens.