Dr. Wierda on Novel Therapies in Relapsed/Refractory CLL

William G. Wierda, MD, PhD
Published: Wednesday, Mar 13, 2019



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

Chemoimmunotherapy regimens have long been the standard of care in the frontline setting, and things get a little more challenging when talking about novel treatment strategies, such as ibrutinib (Imbruvica)-based therapies, Wierda says. However, recent encouraging data with the BTK inhibitor in combination with other agents suggest this could be a new frontline standard approach. For patients who progress on frontline ibrutinib or treatment with a CD20-directed antibody, there are a couple of options. For example, there are data showing that the BLC-2 inhibitor venetoclax (Venclexta) has a reasonable response rate in patients with CLL who progress on treatment with ibrutinib.

There are also data suggesting that the combination of a PI3K inhibitor and a CD20-directed monoclonal antibody has promise in the second-line setting. PI3K inhibitors have some added toxicity; therefore, Wierda suggests the use of venetoclax following ibrutinib. Other strategies like reversible BTK inhibitors and chimeric antigen receptor T-cell therapy are being explored.
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William G. Wierda, MD, PhD, professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses novel therapies in patients with relapsed/refractory chronic lymphocytic leukemia (CLL).

Chemoimmunotherapy regimens have long been the standard of care in the frontline setting, and things get a little more challenging when talking about novel treatment strategies, such as ibrutinib (Imbruvica)-based therapies, Wierda says. However, recent encouraging data with the BTK inhibitor in combination with other agents suggest this could be a new frontline standard approach. For patients who progress on frontline ibrutinib or treatment with a CD20-directed antibody, there are a couple of options. For example, there are data showing that the BLC-2 inhibitor venetoclax (Venclexta) has a reasonable response rate in patients with CLL who progress on treatment with ibrutinib.

There are also data suggesting that the combination of a PI3K inhibitor and a CD20-directed monoclonal antibody has promise in the second-line setting. PI3K inhibitors have some added toxicity; therefore, Wierda suggests the use of venetoclax following ibrutinib. Other strategies like reversible BTK inhibitors and chimeric antigen receptor T-cell therapy are being explored.



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Community Practice Connections™: Addressing Post-Transplant Obstacles: Current and Emerging Strategies to Evolve the Standard of Care for Patients With Graft-Versus-Host DiseaseMar 28, 20192.0
2017 Year in Review™: Clinical Impact of Immunotherapies in the Treatment of CancerMar 30, 20191.75
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