EHA 2019 | Rapid development in the CLL treatment landscape

Treatment in CLL is very rapidly developing and in first line, so in the last six to seven months we’ve had four really important trials, which have compared targeted treatment against chemoimmunotherapy and all of those trials have shown a significant advantage for the non-chemotherapy single agents or combinations. We can divide the front line patients in CLL into those with 17P-P53 dysfunction, and those patients we’ve treated for several years with non-chemotherapy, so ibrutinib the based treatment on how very good the outcome is compared to chemotherapy.

The majority of the patients who aren’t 17P deleted, we have choices. First of all, at the moment those trials are relatively immature and in certain countries in the UK, we can’t use those therapies at the moment until the funding is agreed, but if you take that out of the equation I think we have a choice between ibrutinib monotherapy so if the poorest patients or venetoclax plus obinutuzumab, the advances of the latter being that we have a fixed duration of only 12 months of therapy. I guess at the moment the choices are between chemoimmunotherapy and maybe some patients where that’s still an acceptable option, the good risk mutation patients, where we see prolonged remissions after chemotherapy. Ibrutinib probably is a monotherapy because although the trials I’ve used antibodies, we’re really not seeing an obvious advantage on antibody on the BTK-inhibitor and then venetoclax with obinutuzumab in front line. It’s a really exciting time because I think we’re moving to fixed durations of therapy with the potential to eradicate disease and probably with the potential to cure some patients in front line CLL.