Dr. Stephens Discusses Optimizing Treatment Selection in CLL

Deborah M. Stephens, DO, director of the CLL and Lymphoma Program, Huntsman Cancer Institute, discusses optimizing treatment selection in chronic lymphocytic leukemia (CLL).

Numerous treatment options are available for use in patients with CLL, which means that initial treatment selection should consider the toxicity profile and length of each regimen, Stephens explains.

Ultimately, standard chemoimmunotherapy is being used less in clinical practice and should not be considered for patients with unmutated IGHV, 17p deletion, or TP53-mutated CLL, Stephens explains. However, chemoimmunotherapy could still be considered for some patients with low-risk disease.

In cases of younger, high-risk patients who prefer time-limited therapy, venetoclax (Venclexta) in combination with obinutuzumab (Gazyva) given for 1 year could be utilized, Stephens says.

Additionally, BTK inhibitors offer oral options to patients who’d prefer not to come into the clinic for intravenous infusions. Data from head-to-head clinical trials comparing BTK inhibitors have emerged, suggesting that the agents yield similar efficacy for patients with CLL. However, the data also suggest that second-generation BTK inhibitors like acalabrutinib (Calquence) and zanubrutinib (Brukinsa) are better tolerated vs the first-generation inhibitor ibrutinib (Imbruvica), Stephens says. Notably, zanubrutinib is not yet FDA approved in CLL, so acalabrutinib should be selected in patients who require a less toxic BTK inhibitor vs ibrutinib, Stephens concludes.