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Duvelisib Provides CLL Patients With a Later Line of Therapy

Brittany Lovely
Published: Thursday, Jan 24, 2019

Ian W. Flinn, MD, PhD

Ian W. Flinn, MD, PhD
There is a need for new agents in the second and third line for patients with relapsed/refractory (r/r) chronic lymphocytic leukemia (CLL), according to Ian W. Flinn, MD, PhD. In September 2018, the FDA helped fill the void, approving duvelisib (Copiktra) for adult patients with r/r CLL who have received at least 2 prior treatments.

, Flinn discussed the agent’s potential impact on patients with CLL. Flinn is director of lymphoma research at Sarah Cannon and the Sarah Cannon Center for Blood Cancer at Tennessee Oncology and TriStar Centennial Medical Center, based in Nashville, Tennessee. He serves as the lead investigator of the DYNAMO and DUO studies in duvelisib.

OncLive: How does duvelisib affect the treatment paradigm for CLL?

Flinn: The CLL treatment paradigm has changed significantly over the past few years. We’re seeing use of targeted therapies, such as BTK and BCL2 inhibitors, earlier in the course of disease and getting away from the chemotherapy of old. As a consequence, we need new therapies and we need new treatments for patients who have received those therapies but have relapsed. This is where duvelisib comes in. There’s a need in the second and third line for patients to receive new agents, and, because of its mechanism of action, duvelisib is ideally suited for this setting.

How is duvelisib different from other PI3K inhibitors?

Duvelisib is an inhibitor for both the delta and gamma isoforms of PI3K. The only other currently approved PI3K inhibitor for CLL is idelalisib [Zydelig], which is a pure delta isoform inhibitor. We know that the delta isoform is important because it is expressed in the malignant cells, but the gamma isoform is important in the microenvironment that is supporting the growth and proliferation of CLL cells.
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