Dr. Awan on Future of Combo Regimens in CLL Treatment Paradigm

Farrukh Awan, MD, associate professor, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, discusses the future of combination therapies in chronic lymphocytic leukemia (CLL).

The advent of combination regimens in CLL was a popular topic of discussion at the 2019 ASH Annual Meeting, says Awan. The idea with all these studies, such as those evaluating the combination of venetoclax (Venclexta) and ibrutinib (Imbruvica) or venetoclax and acalabrutinib (Calquence), is to combine all these agents in a rational manner and use minimal residual disease as an end point.

If patients can be brought into a deep remission, in the peripheral blood or bone marrow, then those patients can discontinue therapy and, hopefully, sustain their remission for an extended period of time, explains Awan. This idea is very exciting but more follow-up is needed. Specifically, investigators want to understand what should be done if the disease returns. Can these agents be used as salvage therapy?

Some exciting emerging data suggest that there are ways to manage those patients safely, says Awan. The key takeaway is that all these options are in the process of being developed further, especially the combinations, and hopefully these efforts will result in the use of all these treatments either sequentially or concurrently to improve outcomes, concludes Awan.