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CLL-IPI an Essential Tool for Determining Treatment Approaches

Gina Columbus @ginacolumbusonc
Published: Wednesday, May 17, 2017

Sameer A. Parikh, MD

Sameer A. Parikh, MD

The therapeutic armamentarium of chronic lymphocytic leukemia (CLL) has quickly expanded over the years beyond the standard fludarabine, cyclophosphamide, and rituximab (FCR) regimen to include promising targeted options, such as ibrutinib (Imbruvica), idelalisib (Zydelig), and venetoclax (Venclexta).

State of the Science Summit on Hematologic Malignancies.

OncLive: Please provide an overview of your lecture on CLL.

Parikh: I broke down the talk into several different parts. The first part was prognosis in patients with CLL who are newly diagnosed and don’t yet meet indication for therapy. Roughly two-thirds of all our patients at the time of diagnosis are early stage, asymptomatic, and do not need any treatment. There are a myriad of prognostic markers available in this particular field to be able to tell our patients when they are likely to need treatment. 

mutation status, and serum β2-microglobulin concentration. This will allow us to prognosticate when these patients are going to need therapy. We try do clearly obtain this for all of our patients, [especially for those who are] newly diagnosed and don’t need treatment yet. 

How do you choose a frontline therapy for your patients?

Frontline therapy in CLL has evolved over the years and, with the introduction of novel targeted therapies, this has changed quite a bit. One of the most important [approaches] that has come out is targeting the BCR pathway, [with treatments such as] ibrutinib, idelalisib, and BCL-2 antagonists, including venetoclax. There are several major phase III clinical trials that have compared conventional cytotoxic chemotherapy—including FCR and bendamustine and rituximab (Rituxan; BR)—to novel agents. The results of these are all pending. 
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