Dr. Woyach on Frontline Treatment Options in CLL

Jennifer Woyach, MD, associate professor, The Ohio State University Comprehensive Cancer Center—James, discusses frontline treatment options for patients with chronic lymphocytic leukemia (CLL).

Although the fixed duration of venetoclax (Venclexta) in combination with obinutuzumab (Gazyva) may be efficacious, the data with ibrutinib (Imbruvica) and acalabrutinib (Calquence) appear more robust in high-risk patients with a TP53 mutation or a 17p deletion.

Safety and convenience are also considered when choosing between regimens, says Woyach.

Ibrutinib is associated with greater toxicity including atrial fibrillation, hypertension, risk of bleeding, arthralgia, myalgia, diarrhea, bruising, and gastrointestinal reflux. The majority of these adverse events are noted with acalabrutinib at a lower frequency; however, acalabrutinib is given twice daily as opposed to ibrutinib which is given once daily.

Although venetoclax/obinutuzumab is a fixed duration regimen, the dose-escalation of venetoclax in addition to obinutuzumab can be labor intensive and time consuming for patients, concludes Woyach.