Ryan W. Jacobs, MD
There have been major breakthroughs in the treatment of patients with chronic lymphocytic leukemia (CLL), explained Ryan W. Jacobs, MD, such as the addition of the small molecule inhibitors ibrutinib (Imbruvica), venetoclax (Venclexta), and idelalisib (Zydelig).
State of the Science Summit™ on Hematologic Malignancies, Jacobs, a physician of Levine Cancer Institute, discussed the use of small molecule inhibitors in the treatment of patients with CLL.
OncLive: How have these inhibitors impacted the treatment paradigm?
In the frontline setting, ibrutinib is still the only small molecule inhibitor that is approved by the FDA. When you're talking about use of novel treatments in the frontline setting, you're specifically making decisions between chemoimmunotherapy that we have used for years and ibrutinib, which has been FDA approved in the frontline setting since 2016.
It's significant in that sense. It's also significant in the sense that it's the first treatment with a new small molecule inhibitor that involves defined treatment timelines. Patients on that study were only treated with venetoclax for 2 years and rituximab for 6 months toward the beginning of treatment. Therapy was stopped in responding patients after 2 years. There has been hope for a long time that we can get away from recommendations for indefinite treatment because small molecule inhibitors are expensive and have toxicities.
How has ibrutinib demonstrated success in treating chronic graft-versus-host disease (GVHD)?
At Levine Cancer Institute, rates of chronic GVHD are quite low with our approach of using posttransplant cyclophosphamide. For patients who ultimately develop chronic GVHD that is refractory to steroids, ibrutinib represents the first and only approval by the FDA for this population.
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