Dr. Choi on Impact of Frontline Treatment Decisions on Relapsed/Refractory CLL

Michael Choi, MD, a medical staff physician and associate clinical professor of medicine at the University of California, San Diego (UCSD) Medical Center, discusses how up-front treatment decisions impact what options can be given in the relapsed/refractory setting for patients with chronic lymphocytic leukemia (CLL).

With defined durations of treatment, it is expected that all treatment options given in the first-line setting will be maintained as options upon relapse because patients will not have progressed or will not have developed overt clinical resistance to many of these agents; however, that theory needs to be tested, admits Choi. Some initial data indicate that patients who had achieved complete remission on venetoclax (Venclexta), stopped, and then resumed venetoclax upon progression, experienced equally excellent responses to the agent the second time around. If those results are repeated in other trials, that will support that this strategy can help preserve treatment options, says Choi.

For patients with CLL who stay on a BTK inhibitor, progress on a BCL-2 inhibitor, or have to stop either agent due to toxicity, it is clear that switching to other drug classes is the standard of care in the second-line setting, adds Choi. Many other treatment options are available in the second-line setting, including PI3K inhibitors and clinical trials, concludes Choi.