Joanna M. Rhodes, MD, MSCE

Panelists discuss how the positive BRUIN CLL-321 phase 3 trial results support pirtobrutinib use after covalent BTK inhibitor exposure and consider its role in second-line versus third-line treatment sequencing.

Panelists discuss how clinical trial data supports switching between different covalent BTK inhibitors for intolerance management, with 60-70% of patients experiencing resolution of the original toxicity.

Panelists discuss how to define true BTK inhibitor intolerance versus manageable side effects and describe successful strategies for switching between covalent BTK inhibitors to maintain treatment efficacy.

Panelists discuss how retreatment with venetoclax may be appropriate in certain scenarios despite prior exposure, though continuous BTK inhibitor therapy is often preferred for patients with high-risk disease features.

Panelists discuss how to manage BTK inhibitor-related adverse events including atrial fibrillation, bleeding, and gastrointestinal toxicities through dose modifications, supportive care, and potential drug switching strategies.

Panelists discuss how sequencing therapies becomes challenging when using combination regimens like acalabrutinib-venetoclax in frontline treatment, requiring careful consideration of retreatment strategies and resistance mutation testing.

Panelists discuss how they approach prognostic marker testing at relapse, the importance of ruling out Richter's transformation, and timing of treatment initiation based on disease characteristics and progression patterns.

Panelists discuss how a patient with CLL with initially low-risk disease and mutated IGHV unexpectedly relapsed early after receiving venetoclax-obinutuzumab treatment with acquisition of high-risk features, presenting unique treatment challenges.

Panelists discuss how their institutions organize multidisciplinary teams for chronic lymphocytic leukemia care, detailing the specific roles of various specialists including oncologists, nurses, pharmacists, and cardiologists in coordinating comprehensive patient care, managing adverse events, and addressing treatment-related complications throughout the course of therapy.

Panelists discuss how emerging resistance patterns in chronic lymphocytic leukemia influence their approach to treatment sequencing, considering the mechanisms of resistance to different drug classes and how this knowledge informs the selection and order of therapies to maximize long-term disease control and patient outcomes.

Panelists discuss how they balance the potential benefits of aggressive first-line treatment in chronic lymphocytic leukemia against the importance of preserving effective options for subsequent lines of therapy, considering factors such as patient prognosis, treatment goals, and the evolving landscape of available therapies.

Panelists discuss how they approach treatment sequencing in relapsed/refractory chronic lymphocytic leukemia (CLL), considering primary factors such as prior therapies, mechanisms of resistance, patient characteristics, and treatment goals to optimize the order and selection of subsequent therapies for improved long-term outcomes.

Panelists discuss how they approach treatment selection for multi-refractory chronic lymphocytic leukemia (CLL) patients, considering factors such as prior therapy responses, patient fitness, and disease characteristics to guide choices among available options, including CAR T-cell therapy, while also addressing the limitations and challenges associated with each treatment modality in their decision-making process.

Panelists discuss how various additional treatment options for relapsed/refractory chronic lymphocytic leukemia (CLL) are considered, including CAR-T cell therapy, immunomodulatory drugs like lenalidomide, chemoimmunotherapy regimens, and other emerging therapies, highlighting their potential roles in the evolving treatment landscape.

Panelists discuss how they evaluate patients for tumor lysis syndrome (TLS) risk, considering factors such as tumor burden, renal function, and prior therapies, and how this assessment influences their decision between prescribing a non-covalent BTK inhibitor or a venetoclax-based regimen for chronic lymphocytic leukemia treatment.

Panelists discuss how utilizing pirtobrutinib in clinical practice, focusing on its application in patients who have developed resistance or intolerance to prior BTK inhibitors, as well as in those who have shown resistance to both BTK and BCL-2 inhibitors in chronic lymphocytic leukemia treatment.

Panelists discuss how the non-covalent BTK inhibitor pirtobrutinib has shown promising results in the BRUIN clinical trials for both BTK inhibitor-naive and previously treated chronic lymphocytic leukemia patients, reviewing key efficacy and safety data presented at recent hematology conferences.

Panelists discuss how they assess patients for resistance to first-line BTK inhibitor therapy in chronic lymphocytic leukemia, emphasizing the importance of clinical evaluation, laboratory testing, and genetic analysis in determining the presence and mechanisms of resistance to guide subsequent treatment decisions.

Panelists discuss how treatment approaches are tailored differently for patients with rapid, aggressive chronic lymphocytic leukemia progression versus those with slower, less aggressive disease, considering factors such as urgency of intervention, choice of therapy intensity, and long-term management strategies.

Panelists discuss how various patient-specific factors, including age, comorbidities, performance status, disease aggressiveness, symptoms, and biomarkers, are carefully considered to guide the selection of optimal treatment strategies for individuals with chronic lymphocytic leukemia (CLL).

Panelists discuss how the choice of prior therapy between BTK inhibitors and BCL2 inhibitors influences subsequent treatment decisions in chronic lymphocytic leukemia (CLL), considering factors such as resistance mechanisms, toxicity profiles, and patient-specific characteristics.

Panelists discuss the current standard of care and treatment landscape for patients with chronic lymphocytic leukemia.

A panel of expert oncologists offer closing thoughts on the future treatment landscape and unmet needs in CLL.

Expert oncologists explore emerging therapies being investigated in CLL, including BTKi degraders, CAR-T therapy, and bispecific antibodies, and discussed their potential impact in shaping the future of CLL treatment.

The expert panel discusses recent data regarding the mechanisms of resistance to non-covalent BTK inhibitors in CLL.

Jacqueline Barrientos, MD, MS, discusses the role of non-covalent BTK inhibitors in R/R CLL and provided concise comments on the latest data, including insights from the ongoing BRUIN and Bellwave trials.

Javier Pinilla, MD, PhD explores evidence on molecular mechanisms leading to resistance in second-generation BTK inhibitors for CLL, providing insights from recently presented data at ASH 2023.

A panel of expert oncologists explore the influence of hypertension risk and other cardiovascular AEs in guiding treatment selection with BTKis, sharing insights from ASH 2023.

Faculty provide insights into the selection of BTK inhibitors, emphasizing the role of efficacy, toxicity, and quality of life data in treatment decisions, and exploring the impact of MAIC data.

Panel experts examine considerations for BTKi-based strategies in R/R CLL, highlighting pivotal findings from head-to-head trials, including acalabrutinib vs ibrutinib in ELEVATE-RR and zanubrutinib vs ibrutinib in ALPINE, covering safety, quality of life, and extended follow-up data.