Updated clinical practice guidelines from the National Comprehensive Cancer Network (NCCN) review patient selection for the use of agents such as ibrutinib for the treatment of chronic lymphocytic leukemia.
At the 2019 Hematology/Oncology Pharmacy Association Annual Conference, Alison Duffy, PharmD, BCOP, associate professor at the University of Maryland School of Pharmacy and clinical specialist in oncology at the University of Maryland Greenebaum Comprehensive Cancer Center, discussed the recent updates to the National Comprehensive Cancer Network (NCCN) clinical practice guidelines for the management of chronic lymphocytic leukemia (CLL), including patient selection for the use of ibrutinib.
Previously, for patients that did not have deletion 17p or the TP53 mutations, the guidelines were more stratified based on age, based on fitness, based on comorbidities in terms of using the more aggressive chemoimmunotherapy options for those patients that are young and fit, as opposed to more, sort of, gentler chemoimmunotherapy or single agent options for those older, more frail patients. Now, across the board, based on if patients do or do not have that set of genetic abnormality, if they’re young, fit, have comorbidities or not, ibrutinib is now the only category 1 recommendation from NCCN. Certainly, those other options that I mentioned, the FCR [fludarabine, cyclophosphamide, and rituximab] regimen, can still be considered as sort of other options for patients that might not be candidates for ibrutinib, those young, fit patients, and again agents such as chlorambucil with obinutuzumab similarly is another regimen that can be used, especially in those older, or more frail, unfit patients.
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