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ASH 2024 | Key updates and changes to the ESMO clinical practice guidelines for CLL
Barbara Eichhorst, MD, University Hospital Cologne, Cologne, Germany, comments on the updates to the ESMO clinical practice guidelines for chronic lymphocytic leukemia (CLL), highlighting the shift in recommendations for first-line treatment to ibrutinib and venetoclax for fit patients with unmutated IGHV status. Dr Eichhorst also notes changes in the sequencing of BTK inhibitors (BTKi), recommending acalabrutinib and zanubrutinib as first choices, with ibrutinib as a third choice due to its side effect profile. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI-generated)
Together with Paolo Ghia, we published the update of the ESMO guidance, which was necessary due to two facts. One of them was at the last ASH meeting and then this year publication of the FLAIR study data from a study where ibrutinib and venetoclax was given MRD-guided. This is in many countries not reimbursed, but still we saw particularly in younger and fit patients without severe cardiac comorbidities that this is an excellent regimen, particularly for patients with unmutated IGHV status and that was the major change that now IV is the first recommendation for fit patients with unmutated IGHV status...
Together with Paolo Ghia, we published the update of the ESMO guidance, which was necessary due to two facts. One of them was at the last ASH meeting and then this year publication of the FLAIR study data from a study where ibrutinib and venetoclax was given MRD-guided. This is in many countries not reimbursed, but still we saw particularly in younger and fit patients without severe cardiac comorbidities that this is an excellent regimen, particularly for patients with unmutated IGHV status and that was the major change that now IV is the first recommendation for fit patients with unmutated IGHV status.
The other implementation was that also we suspect when we would recommend when continuous BTKi is used in the first place, we recommend acalabrutinib, zanubrutinib, and then ibrutinib as only the third choice because of the side effect profile. And then in relapsed setting, the new information is that now pirtobrutinib, the non-covalent binding BTK inhibitor, which is not yet approved by the EMA, but we expect soon will, and that this is already mentioned as a relapse treatment option for double exposed or double refractory patients to BTKi and BCL2 inhibitors.
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Disclosures
Miltenyi: Consultancy; MSD: Consultancy, Speakers Bureau; Hoffmann-La Roche: Research Funding, Speakers Bureau; AstraZeneca: Consultancy, Research Funding, Speakers Bureau; Kite: Consultancy, Speakers Bureau; BeiGene: Consultancy, Research Funding, Speakers Bureau; Roche: Research Funding, Speakers Bureau; AbbVie: Consultancy, Research Funding, Speakers Bureau; Janssen: Consultancy, Research Funding, Speakers Bureau; Lilly: Consultancy.
