Spotlight from JADPRO Live 2023

CLL: The Evolving Landscape of Frontline Therapy

Christopher D'Andrea, PA-C, of the Cleveland Clinic, discusses the currently recommended agents for frontline therapy in chronic lymphocytic leukemia (CLL), the latest trial data, and real-world practice of treatment medications.


Christopher D’Andrea:

I had the pleasure of going to the talk today entitled "The Evolving Landscape and the Frontline Treatment of CLL." They did a fantastic job. I think the way I would summarize or describe this presentation is it's for anybody who's ever seen a patient with CLL and who continues to treat these patients. Whether you're new or you've been in the business practicing and managing these patients for a number of years, I think you're going to be able to take something out of this presentation.

So, my key takeaways are, particularly for somebody who's new in the treatment of patients with CLL, I think you'll find it to be a nice synopsis in trying to wrap your head around how we manage these patients and, particularly, when to treat. As we know, this is a chronic condition, so it's not known to be curative with conventional therapies. And so I think it's very important to understand the reasons why we would commit somebody to treatment, and then to be able to evaluate your patients individually to determine who needs treatment and who can be watched and monitored going forward. So I think that's extremely beneficial in this talk for those that have been new to the treatment of these patients.

Additionally, I would say that they did an excellent job of describing the current landscape of treatment therapy options, even for providers who have been doing this for a number of years. There have been a number of new therapies over the last 5 to 10 years that have emerged on the scene for the treatment of CLL, and I thought they did a fantastic job of outlining some of those treatment options.

So more in depth, they talked specifically about some of the current data, specifically the CLL14 trial, looking at venetoclax in combination with obinutuzumab, and they presented the 6-year follow-up data on that therapy regimen. They then went in and talked further about the BTK inhibitors, and how to navigate maybe which BTK inhibitor might be more appropriate for a type of patient.

They did an excellent job of describing some patient case scenarios where they went through and identified specific needs of a patient that may or may not influence you in considering a treatment option.

One of the things that I thought was really cool that I took away from, was the comparison that they presented with the different BTK inhibitors. As we know, those have emerged on the scene. There are a number of different drugs to choose from, including ibrutinib, acalabrutinib, zanubrutinib, and I thought they did a great job of just summarizing the considerations.

For example, that ibrutinib, of course, being the original one in this space, and how we've evolved over time to develop second and third generation drugs. Acalabrutinib is typically having a more favorable bleeding profile, or blur risk for bleeding. So that's something they might want to consider in your patients who are maybe on anticoagulation, or perhaps have history of bleeding disorders. And then, talking also about zanubrutinib, and how there may be some more flexibility with dose modifications to manage treatment-related side effects with that particular drug, and how that class of medications has evolved over time. So that was one of the key points that I felt was really nice in taking away.

And they also did an excellent job of just talking about the real world practice of these medications. We can read studies, we can read up on the data, but what are we seeing in practice is, I think, the most relevant thing for any clinician to be aware of when treating CLL and using these particular medications is, how do you manage that patient who's in front of you, and what things do you need to consider relative to that patient? So overall, as I said, I think they did a fantastic job.