BTK Inhibitors in Relapsed/Refractory Chronic Lymphocytic Leukemia

Switching focus to the second-line setting, expert hematologist-oncologists evaluate the continued role of BTK inhibitors in chronic lymphocytic leukemia.


Sonali M. Smith, MD: What we’ve talked about so far has been the frontline setting, and you’ve heard about some of the NCCN [National Comprehensive Cancer Network] indications and some of the guidelines there. I’m going to switch now to the relapsed and refractory setting, and I’m going to ask Sameer to talk to us a bit about the ASCEND trial 4-year follow-up and what that might mean for practice.

Sameer A. Parikh, MD: I think ASCEND was an important study because it was one of the first that compared 2 novel agents, if you will, in the relapsed/refractory setting for chronic lymphocytic leukemia [CLL]. To remind everyone, ASCEND was a phase 3 study that compared acalabrutinib at a dose of 100 mg twice a day to the investigator’s choice of either idelalisib and rituximab, or bendamustine and rituximab. In this study, there was a clear improvement in progression-free survival with the use of acalabrutinib. About three-quarters of all patients in the comparator arm ended up being on idelalisib as investigator’s choice, but regardless of what treatment was used in the comparator arm, acalabrutinib therapy was associated with improved progression-free survival. That showed and paved the way for approval of acalabrutinib in the relapsed setting for CLL and is available in that area for patients who need treatment after frontline chemoimmunotherapy, which is the vast majority of the patients, at least right now.

Transcript edited for clarity.

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