Dr. Choi on Frontline Treatment Considerations in CLL

Michael Choi, MD, an associate clinical professor of medicine at the University of California, San Diego (UCSD) Medical Center, discusses frontline treatment considerations in chronic lymphocytic leukemia (CLL).

BTK inhibitors and BCL-2 inhibitors are 2 of the most commonly used drug classes in CLL, says Choi. Patients with newly diagnosed disease can receive ibrutinib (Imbruvica), acalabrutinib (Calquence), or venetoclax (Venclexta) in combination with obinutuzumab (Gazyva). Long-term follow-up with BTK inhibitors shows that the agents are safe and that most patients who remain on therapy will remain in remission, says Choi. The toxicities with these agents are mild, but usually manageable, adds Choi.

The combination of venetoclax and obinutuzumab is given as a 1-year treatment with the expectation that patients will remain in remission for several years. The combination is more intensive, so patients should be closely monitored for tumor lysis syndrome and undergo serial laboratory assessments; however, most patients can tolerate the combination as the pivotal trial was intended for older patients with other comorbidities, says Choi.

Based on the rates of atrial fibrillation or bleeding observed with BTK inhibitors, and the concern for tumor lysis syndrome with venetoclax, treatment can be tailored to avoid potential toxicity concerns and adhere to patients’ preferences, concludes Choi.