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CLL Landscape Continues to Expand With Addition of Venetoclax

Angelica Welch
Published: Monday, Oct 01, 2018

Javier A. Pinilla-Ibarz, MD, PhD

Javier A. Pinilla-Ibarz, MD, PhD

The field of chronic lymphocytic leukemia (CLL) has experienced a number of therapeutic advances, with multiple new agents approved and even more being explored in clinical trials. According to Javier A. Pinilla-Ibarz, MD, PhD, combinations may be the future of frontline treatment.

on Hematologic Malignancies, Pinilla-Ibarz, a senior member of Moffitt Cancer Center, discussed updates in the treatment of patients with CLL.

OncLive®: How would you describe the current CLL treatment landscape?

Pinilla-Ibarz: We are quite excited in the world of CLL, and we are so lucky to have so many drugs coming down the pike. The highlight of my talk was the combination of ibrutinib plus venetoclax, data of which were presented at the 2018 ASCO Annual Meeting and 2018 EHA Congress in the CAPTIVATE trial. This trial looked at the frontline combination of these 2 very important drugs, which were recently approved for the treatment of patients with CLL. The data were quite remarkable in terms of complete remission, and more importantly, MRD negativity. We know that these outcomes are associated with very long progression-free survival (PFS). However, we do not have all the data yet. We need to follow those trials for a long period of time. The hope is to have a limited therapy of 1 year to 15 months in the frontline setting or 2 years in the relapsed/refractory setting.

We have a very exciting combination coming up with the CLL14 study, which is evaluating obinutuzumab plus venetoclax compared with obinutuzumab plus chlorambucil. No doubt, there is a plethora of second-generation BTK inhibitors that are entering the phase I and early phase II trials. Most of these drugs are trying to address this area of BTK resistance or secondary mutations. C481S is becoming the classical mutation, in which patients on long-term ibrutinib with high-risk features stop responding or relapse.

What does this mean for the role of chemotherapy?

There is no doubt that chemotherapy continues to fade away. Very soon, we are going to have data for the ALLIANCE study, which is investigating the use of ibrutinib versus ibrutinib plus rituximab (Rituxan) versus bendamustine plus rituximab (BR) in the frontline setting for patients with CLL who are over the age of 65. This is a very important trial; everyone is looking forward to it.
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