Dr. Wierda on Factors to Consider in Frontline Management of CLL

William G. Wierda, MD, PhD, medical director of the Leukemia Center at The University of Texas MD Anderson Cancer Center, discusses factors that physicians should take into account when administering frontline treatment options to patients with chronic lymphocytic leukemia (CLL).

One factor to consider before choosing initial treatment for these patients is whether or not the patient has a 17p deletion, because it has been established that chemoimmunotherapy does not work for such individuals. Rather, they should be treated with an ibrutinib (Imbruvica)-based therapy, according to Wierda.

For patients who have a mutated immunoglobulin gene, as long as they are young, in good shape, and are able to tolerate chemoimmunotherapy, then fludarabine, cyclophosphamide, and rituximab (FCR) should be their standard of care. Moreover, Wierda says these patients should have a vested interest in FCR-based clinical trials because research has shown that over half of treated patients may be cured with first-line FCR therapy.

On the other hand, several options are available for both elderly patients and patients who have an unmutated immunoglobulin gene. Oncologists are particularly interested in the small molecule inhibitors and combining or sequencing them in an attempt to achieve similar effects yielded with chemo-immunotherapy.

According to Wierda, it is imperative that physicians and patients have a detailed discussion about what the treatment objectives are so that patients are treated with the appropriate regimen.