Dr. Barrientos Discusses Combination Strategies in CLL

Jacqueline C. Barrientos, MD, associate professor, The Feinstein Institute for Medical Research, Northwell Health, discusses the impact of recent combination trials for patients with chronic lymphocytic leukemia (CLL).

There is an effort to achieve deeper responses than B-cell receptor signalling agents, explains Barrientos. Moving forward, data such as from the TAP CLARITY trial presented by the UK group during the 2017 ASH Annual Meeting, is going to be important. This trial evaluated ibrutinib (Imbruvica) in combination with venetoclax (Venclexta) in patients with relapsed/refractory CLL. There was no increase in toxicity with the combination, and patients achieved deep responses. The minimal residual disease (MRD) negativity in the patients who had more than 6 cycles was unbelievable, says Barrientos, and many of the patients showed no evidence of disease in the peripheral blood or in the bone marrow. Additionally, many of them achieved complete remission, which was an improvement compared with patients taking ibrutinib as monotherapy. Based on these data, this combination is being tested in the frontline setting.

Other combination studies include the BTK inhibitor ibrutinib with a monoclonal antibody, such as obinutuzumab (Gazyva). Ibrutinib has also been working in this combination. It has been determined that B-cell receptor signaling agents in combination with a monoclonal antibody is safe and will move into the frontline treatment of patients, explains Barrientos.