Neil E. Kay, MD
Novel agents for patients with chronic lymphocytic leukemia (CLL)—including ibrutinib (Imbruvica), venetoclax (Venclexta), idelalisib (Zydelig), and acalabrutinib (Calquence)—have revolutionized the treatment landscape, according to Neil E. Kay, MD; however, the optimal sequence of these therapies remains unclear.
, Kay, a professor of medicine at the Mayo Clinic, discussed the available options and sequencing challenges for patients with relapsed/refractory CLL, as well as next steps for advancing outcomes for this patient population.
OncLive: Please discuss the evolution of personalized medicine and sequencing in CLL.
: [There is a lot to discuss with] the sequencing of treatment options for relapsed/refractory CLL. Since there are so many options available for CLL, it is not as straightforward because we still do not have all the data we need to definitively say which agent would go in which order.
Can you discuss the role of molecular testing for determining the sequence of treatments?
That is a critical step. For patients with IGVH
mutations who have relapsed and do not have a 17p deletion or p53
mutation, they could theoretically be treated with chemoimmunotherapy, such as FCR. The treatment is a reasonable choice for the rare few patients who are relapsed/refractory; however, they need to meet the criteria for not having those adverse prognostic factors.
What are some challenges facing these relapsed patients?
Based on prior clinical trials and prior drugs that were available, once a patient relapses after primary therapy, their responses were short lived. This causes mortality to be much closer [for them].
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