iwCLL 2023 | Sequencing of therapies in patients with R/R CLL
In this video, Florian Simon, MD, University Hospital Cologne, Cologne, Germany, discusses the sequencing of therapies in patients with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL). Current therapies include continuous treatment with BTK inhibitors and time-limited therapies, such as a venetoclax and obinutuzumab combination. Dr Simon concludes the need for further clinical trial data to determine the optimal sequencing of these lines of therapy and whether retreatment is possible. This interview took place at the biennial International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2023 meeting, held in Boston, MA.
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Transcript (edited for clarity)
This is an important topic, but also a difficult topic because we have, as we’ve just mentioned or seen throughout the congress and the last congress which deal with the new advents of therapies in CLL, a plethora of new therapies, which basically just boil down to the two concepts for right now. So we either use time-limited therapy with ven-obi, or we use continuous therapy with BTKi’s or in a different setting, we use the combination of all oral BTKi and BCL2 inhibition...
This is an important topic, but also a difficult topic because we have, as we’ve just mentioned or seen throughout the congress and the last congress which deal with the new advents of therapies in CLL, a plethora of new therapies, which basically just boil down to the two concepts for right now. So we either use time-limited therapy with ven-obi, or we use continuous therapy with BTKi’s or in a different setting, we use the combination of all oral BTKi and BCL2 inhibition. But the question is then with what do we start and what do we give as the next therapy? So what is the sequence of therapies?
And because all of these trials are fairly new, we don’t have the best data or comparable data at all. So we only can use the so far smaller studies which relate to the different sequencing of therapies. And what I think the consensus is right now is that you should look at the patient at the beginning, see what is their preference from their own point of view. So do they want to take an all oral therapy for a continuous amount of time but for example, go on with working as they were before basically. Or do they want to have a time-limited therapy and then be done with it for a specific amount of time? And from there on, we can then have the luxury of then being able to switch to another agent in the case of the primary therapy being for example, with ven-obi, you can then switch to a BTKi. And if you had the primary therapy with BTKi, you can then see did the patient stop the therapy because of intolerance or because of a progressive disease? And if it’s intolerance, you can just switch to a different BTKi, if the patient all in all fared well under BTKi therapy, or you can say we can switch to another therapy.
Where it gets tricky is the part beyond that where we want to see can we, for example, retreat patients with the same therapy if they had a long enough amount of time, which a lot of studies are actually looking into right now, and there’s enough rationale to be doing that, but we are going to have to see more data and this is always exciting to go to these conferences because we see more and more, and I think we can be reassured with our approach so far of switching or retreating with appropriate therapies which worked in the beginning.
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