Dr Jain on Treatment Considerations in the Frontline Management of CLL

Nitin Jain, MD, professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses frontline treatment options for patients with chronic lymphocytic leukemia (CLL), as well as how patient-specific factors and treatment preferences influence clinical decision-making.

Two main approaches are used for frontline treatment in CLL: continuous BTK inhibitor therapy and time-limited venetoclax (Venclexta)-based regimens. BTK inhibitors, such as ibrutinib (Imbruvica), acalabrutinib (Calquence), and zanubrutinib (Brukinsa), are taken daily and indefinitely, with acalabrutinib sometimes combined with obinutuzumab (Gazyva) for six months, Jain says. BTK inhibitors are often favored for their logistical convenience, since they are administered daily as an oral medication that requires fewer clinic visits. However, their use is associated with adverse effects (AEs) such as atrial fibrillation, hypertension, bleeding, and joint pain, which must be considered when selecting this treatment approach, Jain notes.

Alternatively, venetoclax-based therapy, combined with obinutuzumab, is a time-limited treatment option typically administered for one year. This regimen involves close monitoring for tumor lysis syndrome during initiation and carries a higher risk of neutropenia, Jain notes.

As a time-limited therapy, venetoclax-based treatment avoids the long-term AEs associated with BTK inhibitors, offering patients a finite treatment duration, which can be appealing, particularly for younger patients seeking a more defined course of treatment.

Jain also notes that patient-specific factors play a key role in guiding treatment selection. For instance, patients with TP53 mutations or deletion 17pare recommended to undergo continuous BTK inhibitor therapy due to better outcomes with this approach.

Without' was a typo, that should read: "Conversely, venetoclax-based therapy may be more appropriate for patients with cardiovascular risk factors, particularly those at higher risk for atrial fibrillation or bleeding complications, he adds.

Jain concludes by underscoring the role of shared decision-making in selecting treatment strategies, ensuring that the benefits and risks of each regimen are carefully weighed and aligned with both patient preferences and individual clinical factors