Dr. Arora on Sequencing Strategies in CLL

Shagun Arora, MD, assistant clinical professor at the University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, discusses sequencing strategies in the treatment of patients with chronic lymphocytic leukemia (CLL).

Unlike other hematologic malignancies, transplant is not as relevant to the treatment landscape of CLL, explains Arora, though there are some younger patients who stand to benefit from transplant. For the majority of patients who are diagnosed at an older age, Arora recommends frontline ibrutinib (Imbruvica) followed by venetoclax (Venclexta) in combination of rituximab (Rituxan). If the patient progresses, Arora would consider using idelalisib (Zydelig).

There are multiple ongoing trials that are investigating the optimal sequence of agents, says Arora. Chimeric antigen receptor (CAR) T-cell therapy is still in development. The UCSF Helen Diller Family Comprehensive Cancer Center is opening a CAR T cell trial specifically for patients with CLL. Although preliminary data with CLL were not particularly impressive, preclinical data suggested that introducing ibrutinib during infusion may increase the efficacy of the therapy.