Novel Agents Show Promise in Chronic Lymphocytic Leukemia

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An expert discusses new treatment options for patients diagnosed with CLL.

The evolving treatment landscape of chronic lymphocytic leukemia (CLL) is exciting, hopefully prompting more patients to want to join clinical trials, according to Jacqueline C. Barrientos, M.D.

In an interview with CURE’s sister publication, OncLive, Barrientos, who is an associate professor at the Feinstein Institute for Medical Research at Northwell Health, discussed romising agents in the treatment of patients with CLL.

OncLive: Can you discuss some of the new agents we’re seeing in the treatment of CLL?

Barrientos: There are several that are commercially available and several more in the pipeline. I spoke about one of the first new agents that is currently available, but not yet approved for CLL: (Calquence [acalabrutinib]), a second-generation BTK inhibitor. It has shown to have activity in patients that are intolerable to (Imbruvica [ibrutinib]), so in patients for the front-line and relapsed or refractory (settings). There are current phase 3 trials comparing (Imbruvica versus Calquence) in high-risk patients. The data are still maturing and we don’t have the results yet, but it is very interesting. Hopefully this is another option for our patients who are unable to tolerate (Imbruvica).

Now, in terms of PI3K inhibitors, we have (Copiktra [duvelisib]) recently approved in the market following two prior lines of therapy in patients with relapsed or refractory CLL, also with activity in 17p deletion patients. So, that is really good because we always need therapies for those patients. They are always the first ones to relapse.

There is another PI3K delta inhibitor in the pipeline called (Zydelig [idelalisib]). This has demonstrated activity in CLL and in follicular lymphoma and diffuse large B-cell lymphoma. However, PI3K delta inhibitors still have the issue of colitis (occurring as a side effect). So, it is important to remember these are issues (patients should tell their oncologists) so that they can stop the drug when this happens so the (side effect) does not get to a higher grade.

What does the future hold?

The future may include combination strategies in certain patients, particularly those with high-risk disease. There are several new treatment strategies including (Imbruvica) in combination with (Venclexta [venetoclax]) in the relapsed/refractory setting. (In a study), patients showed undetectable minimal residual disease (MRD) and were able to get off of the study drugs. In another study (evaluating this combination) in the front-line setting, patients also showed undetectable (MRD).

With that, we are very excited and we recommend patients continue to consider participating in a clinical trial.