Understanding the Treatment Landscape for CLL - Episode 5

Targeted Therapy for CLL Treatment

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Dr Javier Pinilla-Ibarz leads the discussion on the role of targeted therapy over chemoimmunotherapy as a CLL therapeutic approach and shares NCCN Guidelines recommendations for the use of BTK inhibitors.

Javier Pinilla-Ibarz, MD, PhD: We’re going to discuss the role of BTK [Bruton tyrosine kinase] inhibitors and CLL [chronic lymphocytic leukemia] treatment. We’ll discuss chemoimmunotherapy as recommended to the approach in the old times. Obviously, what are these benefits and how does the NCCN [National Comprehensive Cancer Network] guide that? It has been a dramatic change in paradigm in the last 7 or 8 years with the introduction of BTK inhibitors. We’ve switched for chemoimmunotherapy because these new therapies, BTK inhibitors, and oral therapies can provide long-term progression-free survival. However, these therapies can be checking until disease progression or unacceptable toxicity, which can bring financial toxicity and chronic problems that may in some cases give our patient some issues. Some of them don’t want to be on therapy for life.

There’s no doubt that there are multiple trials. We always say that BTK inhibitors—ibrutinib, acalabrutinib, and others that come in—are being compared with everything. The main example is ibrutinib is compared with chlorambucil, bendamustine-rituximab, FCR [fludarabine, cyclophosphamide, rituximab], obinutuzumab-chlorambucil. In all these trials, there has consistently been superior PFS [progression-free survival] and in some instances even improved overall survival. It’s hard to demonstrate overall survival because the incorporation of these new drugs is able to breach our patients to truly get better outcomes. NCCN Guidelines make category 1 for BTK inhibitors—ibrutinib, acalabrutinib plus or minus obinutuzumab, as well the classic combination of venetoclax plus obinutuzumab. NCCN Guidelines put together every strategy that we can choose depending on the condition of the patient, genomics, age, and preference about which strategy we’re going to choose.

Transcript Edited for Clarity