Dr. Awan on Novel Strategies Under Exploration in Relapsed/Refractory CLL

Farrukh Awan, MD, associate professor in the Department of Internal Medicine at UT Southwestern (UTSW) Medical Center, and member, Division of Hematology and Oncology at UTSW’s Harold C. Simmons Comprehensive Cancer Center and William P. Clements Jr. University Hospital, discusses novel approaches under investigation in relapsed/refractory chronic lymphocytic leukemia (CLL).

Many drugs are slowly making their way through the treatment pipeline, says Awan. For example, duvelisib (Copiktra) received approval from the FDA for use in adult patients with relapsed/refractory CLL or small lymphocytic leukemia who had received at least 2 prior therapies, says Awan.

Additionally, alternative BTK inhibitors are being explored in clinical trials. The rationale behind that research is that those drugs would be utilized in patients who develop resistance to ibrutinib (Imbruvica) or acalabrutinib (Calquence), explains Awan. This concept is particularly exciting because even if a patient progresses on a BTK inhibitor, that does not necessarily mean that other BTK inhibitors would not be effective options for them, says Awan.

Furthermore, UT Southwestern Medical Center has access to some trials examining triplets and CAR T-cell therapy. CAR T-cell therapy is a huge advancement in the CLL treatment paradigm, says Awan, and emerging data with this approach look promising. Ongoing trials are evaluating CAR T-cell therapy in patients who have failed all prior treatment; historically, this patient population has had dismal outcomes, says Awan.

This approach is particularly exciting because patients can potentially be cured without having to undergo an allogeneic stem cell transplant, says Awan. Although patients with relapsed/refractory disease are experiencing favorable responses with CAR T-cell therapy, more follow-up will be needed, concludes Awan.