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ASH 2021 | The future of CLL treatment

Paolo Ghia, MD, Università Vita-Salute San Raffaele, Milan, Italy, describes future advances in the treatment landscape of chronic lymphocytic leukemia (CLL). He highlights the current use of Bruton’s tyrosine kinase (BTK) inhibitors and BCL2 inhibitors such as venetoclax, as well combination therapies. Ongoing clinical trials will additionally assess whether patients will benefit most from fixed-duration regimens or continuous therapy and chimeric antigen receptor (CAR) T-cell therapies have demonstrated promising efficacy in patients with CLL. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.

Transcript (edited for clarity)

The future of treatment of CLL is not clear. I think that the landscape has been revolutionized by the BTK inhibitors and the BCL-2 inhibitors, in particular, venetoclax. More BCL-2 inhibitors are coming up, so we will see if we can have a safer, more manageable drug to be used. At the moment, the frontier seems to be the combination of drugs, two or three drugs together in a fixed duration fashion...

The future of treatment of CLL is not clear. I think that the landscape has been revolutionized by the BTK inhibitors and the BCL-2 inhibitors, in particular, venetoclax. More BCL-2 inhibitors are coming up, so we will see if we can have a safer, more manageable drug to be used. At the moment, the frontier seems to be the combination of drugs, two or three drugs together in a fixed duration fashion.

We still don’t know if this is better than a sequential therapy of single monotherapies or a combination of one therapy with monoclonal antibodies followed by another monotherapy. So that remains to be established and we need studies to see if this is important. Of course, the future is also open for CAR T-cells that here at ASH have been shown even in early lines to be very effective in diffuse large B-cell lymphoma and in other lymphomas. In CLL, we are a little behind. The efficacy still remains low. There will probably be an approval of the first CAR-T in CLL in the next year, but still a lot of work has to be done until it really becomes available for everyone.

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