Understanding treatment options for standard- and high-risk CLL 

 

Dr. Mazyar Shadman
Mazyar Shadman, MD, MPH

Current treatment options of chronic lymphocytic leukemia (CLL) go far beyond chemotherapy. Thanks to novel agents like ibrutinib, acalabrutinib and venetoclax, there are now chemotherapy-free treatment options that can potentially minimize treatment time and side effects for every patient with CLL.   

In a recent conversation on the Oncology Sound Byte podcast, Mazyar Shadman, MD, MPH — an attending physician at Seattle Cancer Care Alliance (SCCA) and a member of the National Comprehensive Cancer Network Guideline Committee for CLL — describes how these treatments work and how providers can add them to their toolbox for treating CLL.   

“With standard-risk patients, we talk to patients about side effects and the length of time they will be on treatment,” he explains. “Venetoclax has the benefit of time-limited therapy, lasting only a year or two, while next-generation BTK inhibitors like acalabrutinib has greatly reduced the side effects associated with ibrutinib.”   

High-risk patients are those who are resistant to an initial course of treatment, or a novel agent, or who have a missing or mutated gene that impacts treatment. While first-line options vary between patients, Dr. Shadman and his team typically start by pursuing drugs such as ibrutinib or acalabrutinib, and then move to a venetoclax-based therapy if needed. Still, Dr. Shadman encourages providers and patients to evaluate potential clinical trials early in the treatment process especially for high-risk patients. SCCA offers access to the latest CAR T-cell therapies for high-risk CLL and offers a trial that aims to improve success rates for patients with relapsed CLL. This trial adds a targeted agent called copanlisib to a regimen that includes chemotherapy and an autologous transplant.   
  
“It’s wise to start the clinical trial conversation as early as possible,” he says. “If you wait to refer for CAR T therapy until after a patient progresses on these novel agents, it may be too late because their disease becomes very difficult to control.”  

 

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