Dr. Wierda on Treatment of Relapsed/Refractory CLL

William G. Wierda, MD, PhD, professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses treatment options for patients with relapsed/refractory chronic lymphocytic leukemia (CLL).

There have been several changes in this setting over the last few years. For patients with relapsed/refractory disease, Wierda says, their initial therapy depends on what they were treated with prior to progression—this is true in the frontline setting, as well as the first and second salvage settings. If patients progressed on chemoimmunotherapy, there are a couple of options available to them, including single-agent ibrutinib (Imbruvica) or venetoclax (Venclexta) plus rituximab (Rituxan).

These 2 therapeutic options are distinguishable in several ways, according to Wierda. With ibrutinib monotherapy, patients will remain on treatment until disease progression or dose-limiting toxicity. Recent data indicate that median progression-free survival with the BTK inhibitor in this setting is approximately 51 months. On the other hand, the combination of venetoclax and rituximab allows for a fixed duration of treatment. Patients are on venetoclax for 2 years and then therapy is stopped; rituximab is given for 6 monthly doses at the initiation of treatment.