Dr. Parikh on the Optimal Frontline Therapy for Patients With CLL

Sameer Parikh, MD, hematologist, Mayo Clinic, discusses first-line therapy choices for patients with chronic lymphocytic leukemia (CLL).

Frontline therapy in CLL has evolved over the years with the introduction of novel targeted therapies, Parikh explains. One of the most notable advances is targeting the BTK pathway, including ibrutinib (Imbruvica), idelalisib (Zydelig), and the BCL-2 antagonist ventoclax (Venclexta). Several major phase III trials have compared conventional cytotoxic chemotherapies, including bendamustine and rituximab (Rituxan; BR) and fludarabine, cyclophosphamide, and rituximab (FCR) to novel agents, results of which are pending.

Clinicians aim to individualize treatments for their patients based on their risk stratification status, he says. If they harbor the 17p deletion, then conventional chemotherapy is a less effective option and they may choose to administer ibrutinib.