ASH 2024 | The evolving frontline management of CLL: are triplets better than doublets?

I had the opportunity this year to participate in the education session where we were discussing doublets versus triplets in frontline CLL and which might be better and how we’re going to know. So in this talk we went through many of the doublets that are currently used in frontline CLL, more standardly, things like acalabrutinib plus obinutuzumab, venetoclax plus obinutuzumab, and ibrutinib plus venetoclax. And then we’re discussing some of the investigational doublets and triplets. Of course, kind of the biggest ones at this meeting would be AV and AVO, so acalabrutinib-containing doublets and triplets as investigated in the AMPLIFY study. But there also are many data coming out with zanabrutinib combinations and other ibrutinib combinations too. So overall, I think it’s pretty hard at this point to say that a triplet is definitively better than a doublet. I’m really excited to see whether there might be some patients that benefit from triplets, maybe those who are younger, those that are fitter, those that are higher risk potentially. And then of course, the doublets that we have in CLL, outside of acalabrutinib and obinutuzumab, where acalabrutinib is given continuously, are really exciting because they do give patients the opportunity to have fairly long off-treatment times. Right now, we do have VO and BTK, BCL2 inhibitor combinations, which have been relatively safe in large patient populations, have exciting efficacy, and I think we just need more and more data to come out to help us decide, are there situations where a triplet is going to be better than a doublet?

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