Allison Winter, MD, hematologist/medical oncologist, Cleveland Clinic, discusses emerging agents in chronic lymphocytic leukemia (CLL).

The pipeline of CLL is rich with investigational combination strategies, says Winter. In addition to safety and efficacy findings, minimal residual disease data may be used to determine which of these combinations will be optimal for patients.

Additionally, novel PI3K inhibitors are emerging in this space and appear to elicit less immune-related adverse effects compared with currently approved PI3K inhibitors, Winter explains. The BTK inhibitor LOXO-305 is another intriguing agent because it can overcome BTK inhibitor resistance. For example, LOXO-305 or potentially CAR T-cell therapy could have utility for heavily pretreated patients who received prior bendamustine and rituximab (Rituxan), ibrutinib (Imbruvica), idelalisib (Zydelig), and venetoclax (Venclexta), concludes Winter. 

Videos

Allison Winter, MD, discusses emerging agents in chronic lymphocytic leukemia.  


Dr. Winter on Emerging Agents in CLL 

Allison Winter, MD, hematologist/medical oncologist, Cleveland Clinic, discusses the role of frontline targeted therapies in chronic lymphocytic leukemia (CLL).

Historically, when it came to frontline treatment selection for patients with CLL, factors such as fluorescence in situ hybridization scores andimmunoglobulin heavy chain results played important roles; however, now that the CLL space is shifting away from the use of chemotherapy, this is no longer the case, Winter says.

Notably, as targeted therapies continue to take the stage in the CLL treatment paradigm, only younger patients with an 

-mutated status, who do not harbor 17p or 11q deletions, are being considered for frontline chemotherapy. The majority of patients with CLL, including those with high-risk disease, are now being treated with targeted therapies, Winter explains.

With the number of targeted therapies available, patient preference is critical. Gaining a deeper understanding of the patient’s life, along with what is important to them, is of paramount importance, especially in terms of optimizing their quality of life, Winter concludes.

Allison Winter, MD, hematologist/medical oncologist, Cleveland Clinic, discusses the role of frontline targeted therapies in chronic lymphocytic leukemia. 








Dr. Winter on the Role of Frontline Targeted Therapies in CLL

Allison Winter, MD, hematologist/medical oncologist, Cleveland Clinic, discusses the utility of PI3K inhibitors in chronic lymphocytic leukemia (CLL).

Patients who have progressed on prior BTK inhibitor therapy and venetoclax (Venclexta)-based therapy should be considered for a PI3K inhibitor as standard of care or within the context of a clinical trial, says Winter.

Investigational PI3K inhibitors, such as zandelisib (ME-401), are being evaluated in ongoing clinical trials for patients with relapsed/refractory CLL. Moreover, the agent appears to have a more favorable immune-related toxicity profile compared with approved PI3K inhibitors, such as idelalisib (Zydelig) and duvelisib (Copiktra), Winter explains. Additionally, the PI3K inhibitor umbralisib is being tested in combination with other agents in a number of ongoing clinical trials in this space, concludes Winter.

Allison Winter, MD, discusses the utility of PI3K inhibitors in chronic lymphocytic leukemia.  



Allison Winter, MD

Articles

Dr. Winter on Emerging Agents in CLL

Dr. Winter on the Role of Frontline Targeted Therapies in CLL

Dr. Winter on the Utility of PI3K Inhibitors in CLL