Dr. Brander Discusses the Frontline Treatment of CLL

Danielle M. Brander, MD, assistant professor of medicine, Duke Cancer Institute, discusses the frontline treatment of patients with chronic lymphocytic leukemia (CLL).

There have been a lot of changes in the treatment options for patients with CLL, says Brander, both in the frontline and relapsed/refractory settings. In frontline, Brander says that much of the effort in the past few years has gone towards identifying patients who may still benefit long-term from chemoimmunotherapy. These are often patients who are young, have a favorable risk indicated by an IGHV-mutation, and no high-risk deletion 11q or 17p. Patients who match this profile can experience 10- to 12-year remissions from frontline therapy with fludarabine-cyclophosphamide-rituximab (Rituxan). Additionally, there may be patients with favorable risk who might be older who may experience a meaningful remission from frontline chemotherapy such as bendamustine and rituximab.

The only FDA-approved targeted agent for the frontline treatment of patients with CLL is ibrutinib (Imbruvica). Recently, a study looking at long-term 5-year follow-up of a cohort of patients who were mainly frontline showed that patients who were not high-risk had very low progression-free survival with ibrutinib.