Jan A. Burger, MD, PhD, tenured professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, “privatdozent” (lecturer) in internal medicine, Albert-Ludwigs University, School of Medicine, Freiberg, Germany, faculty, Graduate School of Biomedical Sciences, University of Texas-Houston Health Science Center, discusses the current landscape of CAR T-cell therapy in chronic lymphocytic leukemia (CLL).

CAR T-cell therapy has generated more consistent and durable responses, especially for patients who go into deeper remission, Burger says. Patients without much active disease would serve as ideal candidates for CAR T-cell therapy, Burger adds. When patients are in a more stable remission, outcomes tend to be better, since the therapy could be used to eradicate residual disease, Burger explains.

CAR T-cell therapy is becoming an alternative treatment prior to allogeneic stem cell transplant (ASCT) in patients with CLL due to favorable toxicity profile of CAR T-cell therapy vs ASCT, Burger concludes.

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Jan A. Burger, MD, PhD, discusses the current landscape of CAR T-cell therapy in chronic lymphocytic leukemia.


Dr. Burger on the Current Landscape of CAR T-Cell Therapy in CLL

Jan A. Burger, MD, PhD, tenured professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, lecturer, internal medicine, Albert-Ludwigs University, School of Medicine, Freiberg, Germany, faculty, Graduate School of Biomedical Sciences, University of Texas-Houston Health Science Center, discusses the changing treatment landscape of chronic lymphocytic leukemia (CLL).

The addition of multiple treatment options has provided a boost in treating CLL, since most patients are doing better than what was previously seen with chemoimmunotherapy, Burger explains. Additionally, patients are experiencing fewer toxicities with these different agents, Burger says.

Progress still needs to be made with new agents, Burger notes. Problems with toxicities and resistance can still arise, Burger continues. However, outcomes and life expectancy have improved for these patients, Burger concludes.

Jan A. Burger, MD, PhD, discusses the changing treatment landscape of chronic lymphocytic leukemia.


Dr. Burger on the Changing Treatment Landscape of CLL

Jan A. Burger, MD, PhD, tenured professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, “privatdozent” (lecturer) in internal medicine, Albert-Ludwigs University, School of Medicine, Freiberg, Germany, faculty, Graduate School of Biomedical Sciences, University of Texas-Houston Health Science Center, discusses the benefit of combination therapy in patients with chronic lymphocytic leukemia (CLL).

BTK inhibitors, which are considered to be the standard of care for most patients with CLL, lie at the center of several studies that are being conducted at MD Anderson and other institutions, according to Burger. These trials are combining BTK inhibitors with either CD20 antibodies, venetoclax (Venclexta), or both, Burger adds. The goal of these studies is to provide patients with deeper remissions, Burger adds.

If a patient’s disease becomes minimal or undetectable, there is an opportunity to stop treatment and reduce treatment time, Burger adds. Reduced time on therapy could provide an advantage, since a shorter treatment course reduces the risk for long-term adverse effects, and it adds convenience for some patients, Burger concludes.

Jan A. Burger, MD, PhD, discusses the benefit of combination therapy in patients with chronic lymphocytic leukemia.

Dr. Burger on the Benefits of Novel Combination Approaches in CLL 

Jan A. Burger, MD, PhD, tenured professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, “privatdozent” (lecturer) in internal medicine, Albert-Ludwigs University, School of Medicine, Freiberg, Germany, faculty, Graduate School of Biomedical Sciences, University of Texas-Houston Health Science Center, discusses choosing frontline therapy in chronic lymphocytic leukemia (CLL).

The BTK inhibitors ibrutinib (Imbruvica) and acalabrutinib (Calquence) are widely utilized frontline options for patients with CLL, Burger explains. Both agents are active and choosing between them is largely based on differences in their toxicity profiles, including blood pressure complications and atrial fibrillation.

The BCL-2 inhibitor venetoclax (Venclexta) is also available for frontline use. Like the BTK inhibitors, venetoclax is given orally. However, the agents differ in that venetoclax, which is often combined with agents like obinutuzumab (Gazyva) or rituximab (Rituxan), is given in a fixed-duration regimen, whereas BTK inhibitors are given continuously for an indefinite period, Burger says.

Ultimately, treatment selection should be based on patient preference, safety profiles, and eligibility for clinical trials, Burger concludes.

Jan A. Burger, MD, PhD, discusses choosing frontline therapy in chronic lymphocytic leukemia.


Dr. Burger on Choosing Frontline Therapy in CLL 

Jan A. Burger, MD, PhD, associate professor, department of leukemia, division of cancer medicine, The University of Texas MD Anderson Cancer Center, discusses the role of minimal residual disease (MRD)-negativity in chronic lymphocytic leukemia (CLL).

With chemoimmunotherapy understanding MRD status was very beneficial, but it is not yet known what the role of MRD-negativity is with the new agents now available in CLL, says Burger.  

With the tyrosine-kinase inhibitors (TKIs) MRD-negativity is not often achieved, yet patients still do well. The concern is, what role will residual disease play? More needs to be studied regarding the biology of the cells that are left behind, says Burger. With the new agents, understanding the role of MRD-negativity is more complex, he adds.

Jan A. Burger, MD, PhD

Articles

Dr. Burger on the Current Landscape of CAR T-Cell Therapy in CLL

Dr. Burger on the Changing Treatment Landscape of CLL

Dr. Burger on the Benefits of Novel Combination Approaches in CLL

Dr. Burger on Choosing Frontline Therapy in CLL

Dr. Jan A. Burger on Role of MRD-Negativity in CLL