Dr. Jacobs Discusses the Frontline Treatment of CLL

Ryan W. Jacobs, MD, physician, Levine Cancer Institute, discusses the frontline treatment of patients with chronic lymphocytic leukemia (CLL).

Currently, the only small molecule inhibitor approved for the frontline treatment of patients with CLL is ibrutinib (Imbruvica). The approval of ibrutinib in this setting was based on data from the RESONATE-2 trial.

The use of novel treatments in the frontline setting is limited to chemoimmunotherapy and ibrutinib, Jacobs says, but the combination of these 2 therapies has shown promise. In a phase II study presented at the 2017 ASH Annual Meeting, ibrutinib combined with fludarabine-cyclophosphamide-rituximab chemoimmunotherapy demonstrated an objective response rate of 100%, including a complete response rate of 40% with or without hematologic recovery.

When choosing frontline treatment for patients, it is important to consider the available data, Jacobs says. Head-to-head data with novel agents in the frontline setting are not yet available. Until then, Jacobs says that the best thing to do is subgroup analyses and cross-trial comparisons.