Dr. Hobbs on Choosing Optimal Second-Line Treatment Option for TKI-Resistant CLL

Gabriela Hobbs, MD, clinical director of Leukemia Service and assistant in medicine at Massachusetts General Hospital, shares advice on how to choose the appropriate second-line treatment option for patients with chronic lymphocytic leukemia (CLL) who are resistant to TKIs.

If a patient with CLL proves to be resistant to a second-generation TKI, subsequent administration of imatinib (Gleevec) would not be recommended, according to Hobbs. Instead, a choice should be made among other second-generation agents. At this point in the treatment journey, is important to ensure that the patient is taking their medications as prescribed and that a BCR-ABL1 kinase mutational analysis is conducted, adds Hobbs; this will help to inform which TKI a patient should receive.

Research presented during the 2020 ASH Annual Meeting & Exposition indicated that some patients who prove to be resistant to a TKI are not often switched to the correct subsequent TKI based on their mutations, says Hobbs. For example, a patient with a T315I mutation should not be put on a second-generation drug; rather, that patient should be switched to ponatinib (Iclusig). Patients who are not switched to the correct TKI can have negative outcomes, Hobbs concludes.