The expansion of targeted agents has shifted the treatment landscape of chronic lymphocytic leukemia (CLL), enabling physicians to focus on combinations and sequences most likely to elicit deep responses with the most curative potential, explained Mazyar Shadman, MD, MPH.
“Ongoing studies will [reveal] the treatment that will provide deep responses with no detectable disease,” said Shadman, an assistant member of Fred Hutchinson Cancer Research Center. “That will give us the opportunity to stop treatment or hold treatment with minimal side effects. As next generations of BTK inhibitors or PI3K inhibitors [come out, we may be able to] combine those drugs with a drug like venetoclax (Venclexta). The idea would be to offer treatment for a limited duration of time and then hopefully cure the patients. If not cure, let them have a disease-free life for as long as possible.”
One novel agent to recently enter the landscape is duvelisib (Copiktra), which was granted FDA approval in September 2018 for the treatment of patients with relapsed/refractory CLL/small lymphocytic lymphoma (CLL/SLL) or relapsed/refractory follicular lymphoma. The CLL/SLL indication is based on data from the phase III DUO trial, which showed a 60% reduction in the risk of disease progression or death compared with ofatumumab (Arzerra), with a median progression-free survival of 16.4 months versus 9.1 months, respectively (HR, 0.40).
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