Treatment Sequencing for Patients With B-Cell Malignancies

This is a video synopsis/summary of an Insights featuring: Nicole Lamanna, MD.

Dr. Lamanna discusses how to sequence Bruton tyrosine kinase (BTK) inhibitors, B-cell lymphoma 2 (BCL2) inhibitors like venetoclax (Venclexta), and newer agents for chronic lymphocytic leukemia (CLL) treatment based on patient factors.

In the frontline setting, choice between BTK inhibitor or venetoclax combinations depends partly on comorbidities and patient preferences regarding oral continuous therapy or time-limited therapy to stop all treatment. If venetoclax is chosen upfront, BTK inhibitors can be utilized at relapse and vice versa, especially if a durable remission over 2-3 years was achieved initially.

Later lines also depend on any changes in comorbidities, prior tolerance, and availability of newer agents like non-covalent BTK inhibitors pirtobrutinib for those refractory to standard BTK inhibitors and venetoclax or novel mechanisms therapies in development. Chimeric antigen receptor (CAR) T cell therapy, though not yet approved in CLL, is another consideration based on patient age and eligibility through clinical trials.

Overall, Dr. Lamanna states optimal CLL sequencing requires assessing comorbidities, prior response history, and integrating newer treatment options as the landscape continues advancing.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.