Neil E. Kay, MD, professor of medicine, Mayo Clinic, discusses combination strategies for patients with chronic lymphocytic leukemia (CLL).
There will always be a role for single-agent ibrutinib (Imbruvica) in the treatment of patients with CLL, says Kay. The ability to tolerate 1 drug is always better than having to tolerate 2. For the individual who is older, such as in their late 70s or early 80s, being on ibrutinib for 4 or 5 years with a good response would be quite reasonable.
However, ibrutinib alone does not induce a high level of complete responses (CRs). If a patient has a CR, ibrutinib will not give them a minimal residual disease (MRD)-negative status. Therefore, combinations will be necessary if the goal is to get to a CR with MRD-negative status. There are ongoing trials that are investigating those combinations with preliminary data that look promising. The combinations are encouraging, explains Kay.