Dr Anderson on Navigating Unanswered Questions in CLL Treatment Selection

“[CLL treatment] isn’t going to be a one-size-fits-all [approach]. It’s going to be a tailored discussion between you and your patient about the right treatment option.”

Mary Ann Anderson, MBBS, FRACP, FRCPA, PhD, an associate professor at Royal Melbourne Hospital and Peter MacCallum Cancer Centre and a clinician scientist at the Walter and Eliza Hall Institute, discussed open questions in chronic lymphocytic leukemia (CLL) treatment selection and highlighted data from the phase 3 CLL17 trial (NCT04608318) comparing continuous and fixed-duration approaches.

The emergence of multiple safe and effective options has left the CLL field with almost more questions than answers, Anderson said. Beyond the initial choice between continuous and fixed-duration therapy, clinicians must also weigh whether to pair a BTK inhibitor with a monoclonal antibody in the continuous setting; with a fixed-duration approach, clinicians face choices of monoclonal antibodies, BTK inhibitors, doublets, and triplets, she explained. Additionally, Anderson pointed out how deciding on whether to utilize minimal residual disease (MRD)–guided treatment, and how to best to sequence later-line therapy also remains unclear in CLL. Considering the individual patient can help ground these decisions, she added.

Key questions, such as which BCL2 and BTK inhibitors to use going forward, are unlikely to be answered by randomized phase 3 data because such trials would be difficult to conduct, Anderson said. Collaborative group studies addressing real-world questions will be increasingly important to help answer these questions, she highlighted.

Anderson pointed to CLL17, which she said goes to the heart of whether patients should receive continuous BTK inhibitor therapy or finite BCL2 inhibitor–based treatment. Although data from CLL17 are still maturing, initial readouts at about 3 years suggest that both approaches produce equally good progression-free survival, even in patients with challenging genetic aberrations, Anderson said. More studies answering such real-world questions will become increasingly important, she concluded.