Dr. Barrientos on Treatment Options for Patients With TP53 Mutations or 17p Deletions in CLL

Jacqueline Claudia Barrientos, MD, MS, an associate professor at the Karches Center for Oncology Research, Feinstein Institutes for Medical Research, as well as an associate professor in the Division of Hematology and Medical Oncology, Department of Medicine, at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, discusses treatment options for patients with chronic lymphocytic leukemia (CLL) who harbor TP53 mutations or 17p deletions.

It is critical to know a patient’s TP53 mutation and 17p deletion status prior to initiating therapy for CLL, says Barrientos. Patients who harbor these aberrations will have suboptimal responses to chemotherapy and should only be considered for targeted therapy, Barrientos explains.

Currently, it is unknown whether these patients should receive a BTK inhibitor, such as ibrutinib (Imbruvica) or acalabrutinib (Calquence), or a BCL-2 inhibitor, such as venetoclax (Venclexta), Barrientos says. There are longer follow-up data with ibrutinib in these patients; however, patients could potentially derive similar benefit from acalabrutinib, a second-generation BTK inhibitor, Barrientos explains.

Although patients with 17p deletions can respond to venetoclax, this subgroup tends to relapse quicker compared with the general CLL population, says Barrientos. As such, perhaps continuous therapy with a BTK inhibitor or alternative combination strategy is optimal in this patient population vs time-limited venetoclax, concludes Barrientos.