Dr. Davids on Frontline Challenges in CLL

Matthew S. Davids, MD, MMSc, associate director, Center for Chronic Lymphocytic Leukemia, Dana-Farber Cancer Institute, and assistant professor of medicine, Harvard Medical School, discusses challenges in the frontline treatment of patients with chronic lymphocytic leukemia (CLL).

One of the biggest challenges, Davids says, is that there are now so many treatment options to choose from in the frontline setting. As such, time should be spent with each individual patient to weigh the pros and cons of the available therapies. For example, although ibrutinib (Imbruvica) is an effective drug in this setting, patients will require continuous treatment with it. For younger patients, this could mean decades of therapy, he stresses.

Investigators are trying to shift toward more of a time-limited treatment approach, where patients can come off therapy if they reach a certain level of benefit. Currently, frontline chemoimmunotherapy offers a time-limited treatment dose, but this regimen can be toxic and lead to infection and other malignancies down the line. With chemotherapy, Davids adds, however, an intermittent approach may allow for the treatment to be initiated in a time-limited fashion. Doing so will limit toxicity and overbearing cost for patients.