At the American Society of Hematology Annual Meeting and Exposition being held December 7-10 in Orlando, Florida, Jennifer Woyach, MD, associate professor at The Ohio State University, sat down with Pharmacy Times® to explain how patient-specific factors can help determine treatment decisions in chronic lymphocytic leukemia. 

One advantage to having so many drugs to choose from is that we can actually use patient-specific factors to help guide treatment decisions. So because of the cardiac toxicities we can see with BTK inhibitors, especially with ibrutintib, I would likely not choose that drug for patients who have a history of atrial fibrillation, especially if it’s uncontrolled. Those that have uncontrolled hypertension, those that are on warfarin. Many of those patients would be better served being on venetoclax, which doesn’t have some of the same side effect profile. And some of those patients actually would be well managed with acalabrutinib too which has a lower risk of some of those cardiac complications.

With venetoclax and obinutuzumab, the biggest challenge I have with that, well I guess there’s 2. One is that the ramp up is a lot more time and labor intensive, but it also requires a lot of fluids. So for patients who maybe have borderline renal function or heart failure, it can be difficult to give them enough fluids to get them through that initial ramp up period with venetoclax and obinutuzumab and I might choose a BTK inhibitor for those patients. As well as patients who just have transportation issues or don’t want to come to the office so often to receive the monoclonal antibody or to have the venetoclax ramp up, they might be better served on the BTK inhibitor.