Optimal Frontline Treatment in Chronic Lymphocytic Leukemia

Jan Burger, MD, PhD; Anthony R. Mato, MD


May 16, 2022

Over the past decade, Bruton tyrosine kinase inhibitors (BTKis) and venetoclax have eclipsed chemoimmunotherapy as optimal treatment for chronic lymphocytic leukemia (CLL) in both the frontline and relapsed/refractory settings. Dr Anthony Mato, of Memorial Sloan Kettering Cancer Center; and Dr Jan Burger, of MD Anderson Cancer Center, both active contributors to this therapeutic evolution, share their views on which factors should be considered when selecting frontline treatment for patients with CLL.

Two approved BTKis — ibrutinib and acalabrutinib — can be used alone or in combination with anti-CD20 antibodies. Dr Mato says these regimens are easy to initiate, require limited patient monitoring, and have high response rates. But this therapy is given continuously until an adverse event, clinical resistance, or progression of disease.

By contrast, venetoclax is given over 12 months in treatment-naive patients and also may prove to be the optimal choice for patients in whom BTKis are contraindicated.

Although both therapies lead to long remissions and are well tolerated, they have not been compared in randomized trials. Both panelists look forward to additional studies and to therapies in development, which may achieve even more durable remissions in CLL patients.


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