Frontline CLL Treatment Landscape and Factors Guiding Therapy Selection

Sameh Gaballa, MD, of Moffitt Cancer Center, opens this OncLive Insights program on treatment-naive chronic lymphocytic leukemia (CLL) by asking where continuous Bruton tyrosine kinase (BTK) inhibitor therapy and fixed-duration, venetoclax-based therapy fit today. M. Yair Levy, MD, of Texas Oncology–Baylor Charles A. Sammons Cancer Center, recalls that chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab worked well in favorable-risk disease but less so in high-risk CLL, and notes that every preferred category 1 option in current guidelines is now a targeted therapy. Andrew H. Lipsky, MD, of Columbia University Irving Medical Center, describes the choice as one among several good options that differ mainly in duration. He asks patients about pill burden and the value of a treatment-free interval, then weighs comorbidities, a medication reconciliation, and prognostic and predictive biomarkers, including whether differences in median progression-free survival of 4, 6, or 7 years would matter to the patient in front of him.