Dr. Brown on Recent Progress in the Treatment Landscape of CLL

Jennifer R. Brown, MD, PhD, director, CLL Center, Dana-Farber Cancer Institute, associate professor of Medicine, Harvard Medical School, discusses the recent progress seen in the treatment landscape of chronic lymphocytic leukemia (CLL), and what still needs to be accomplished going forward.

The real progress has come with multiple new drug approvals in the last few years, says Brown, which has provided several new treatment options that oncologists have never had in the relapsed/refractory setting of CLL.

One such drug is the BTK inhibitor ibrutinib (Imbruvica), which is approved in any line of therapy for patients. Another agent is idelalisib (Zydelig), a PI3k inhibitor, which has been approved in combination with rituximab (Rituxan) for relapsed patients with comorbidities. Moreover, in April 2016, venetoclax (Venclexta) was approved as a treatment for relapsed patients with 17p deletion.

According to Brown, this influx of new drugs for patients with CLL can be described as a sort of “embarrassment of riches.” However, at the same time, she says, there is still much to be learned about how to optimize the use of these drugs in this setting.

The current model calls for sequential single agents, though oncologists know that patients who relapse on ibrutinib, for example, can be quite hard to salvage. Brown says she and others in her field are unsure if such patients will have extended responses to subsequent agents.

Brown is mainly interested in combination therapies that could potentially achieve deeper remissions and allow patients to have longer breaks from therapy.