John C. Byrd, MD, D. Warren Brown Chair of Leukemia Research, professor of medicine, Medicinal Chemistry and Veterinary Biosciences, director, Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, discusses the role of combinations in the treatment of patients with chronic lymphocytic leukemia (CLL).
Both ibrutinib (Imbruvica) and acalabrutinib (Calquence) in combination with venetoclax (Venclexta) are currently being evaluated in trials of patients with CLL. Byrd states that he is moving toward more selective Bruton’s tyrosine kinase (BTK) inhibitors when he is not looking for the immune-modulation that ibrutinib requires. Giving a more selective agent with other therapies has less side effects associated with it.
The recent acalabrutinib approval for mantle cell lymphoma (MCL) falls into The National Comprehensive Cancer Network (NCCN) guideline criteria, although physicians use it off-label in the setting of relapsed disease, says Byrd. In CLL, acalabrutinib and ibrutinib are being investigated in a head-to-head phase III study (NCT02477696; ACE-CL-006) for patients with pretreated CLL, which will answer many questions regarding the 2 regimens.