Susan M. O'Brien, MD, associate director for Clinical Science for the Chao Family Comprehensive Cancer Center, medical director of the Sue and Ralph Stern Center for Cancer Clinical Trials and Research, UC Irvine Health, discusses how ibrutinib (Imbruvica) compares with chemoimmunotherapy as a frontline treatment for patients with chronic lymphocytic leukemia (CLL).

Chemoimmunotherapy, comprised of fludarabine, cyclophosphamide, and rituximab (FCR) is a very effective regimen. However, it is not appropriate for elderly patients who are more likely to benefit from a regimen of chlorambucil plus an anti-CD20 agent, O'Brien explains. The rates of progression-free survival are higher in patients who receive ibrutinib versus those who receive chlorambucil plus obinutuzumab, she adds.

For high-risk patients who relapse on FCR or elderly patients, ibrutinib is a more effective choice in the frontline setting, O'Brien explains.

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Susan M. O'Brien, MD, associate director for Clinical Science for the Chao Family Comprehensive Cancer Center, medical director of the Sue and Ralph Stern Center for Cancer Clinical Trials and Research, UC Irvine Health, discusses how ibrutinib (Imbruvica) compares with chemoimmunotherapy as a frontline treatment for patients with chronic lymphocytic leukemia.

Dr. Susan O'Brien Compares Ibrutinib With Chemoimmunotherapy in Frontline CLL

Susan M. O'Brien, MD, associate director, Clinical Science Medical Director of the Sue and Ralph Stern Center for Cancer Clinical Trials and Research, Chao Family Comprehensive Cancer Center, University of California at Irvine, discusses the use of ibrutinib and idealisib in chronic lymphocytic leukemia (CLL).

One of the advantages to treating patients with either ibrutinib or idelalisib is that neither agent is myelosuppressive. Therefore, chemotherapy-based regimens, which are myelosuppressive, are a difficult choice to administer to patients.

Ibrutinib and idelalisib have also demonstrated improvement in cytopenia. O’Brien says that, for patients with baseline cytopenia, practitioners should not reduce treatment dosage in order to have a rapid improvement. Durable responses have been seen with the use of both agents in the relapsed/refractory setting, she adds, though median progression-free survival (28 months) has only been reached in patients with 17p deletion.

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Dr. O'Brien Discusses Ibrutinib and Idelalisib in CLL

Susan M. O'Brien, MD, Professor, Department of Leukemia, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, discusses the standard of care for patients with chronic lymphocytic leukemia (CLL).

Healthy and fit patients with CLL are eligible to receive a combination of fludarabine, cyclophosphamide, and rituximab (FCR). Clinical trials have demonstrated that this is the most effective treatment regimen currently available for patients with CLL. The randomized German CLL Study Group, the CLL8 trial, demonstrated an overall survival benefit for the FCR regimen, which was one of the first regimens to demonstrate improved survival in CLL.

The standard chemotherapy regimen is generally ineffective in patients with a 17p deletion, which generally results in an incomplete 

 gene or an allelic mutation in the other arm of chromosome 17. O'Brien notes that there is not a current standard for this population, which makes them eligible for clinical trials and allogeneic transplant at first admission.

FCR may not be considered in elderly patients (over 70) and in those that are not fit. If the disease is aggressive and FCR is needed it should be administered with a dose reduction in elderly patients. Fludarabine is renally excreted and most elderly patients have abnormal kidney function, which can lead to overtreating if the normal dose is given.

Dr. Susan O'Brien, from the MD Anderson Cancer Center, Discusses the Standard of Care for CLL

Susan M. O'Brien MD

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Dr. Susan O'Brien Compares Ibrutinib With Chemoimmunotherapy in Frontline CLL

Dr. O'Brien Discusses Ibrutinib and Idelalisib in CLL

Dr. O'Brien Discusses the Standard of Care for CLL