Dr. Awan on Remaining Questions With BTK Inhibitors and Anti-CD20 Combos in CLL

Farrukh Awan, MD, associate professor in the Department of Internal Medicine, UT Southwestern Medical Center (UTSW), and a member of the Division of Hematology and Oncology at UTSW's Harold C. Simmons Comprehensive Cancer Center and William P. Clements Jr. University Hospital, discusses remaining questions regarding the use of BTK inhibitors and CD20-directed monoclonal antibodies in chronic lymphocytic leukemia (CLL).

When determining whether to give a patient with CLL a BTK inhibitor alone or in combination with a CD20-directed antibody, it is important to have a discussion with patients, says Awan. During that conversation, the first question that is considered has to do with what benefit the patient can potentially derive from the addition of the CD20-directed antibody to the BTK inhibitor. Early data indicate that, at least with the addition of rituximab (Rituxan) to ibrutinib (Imbruvica), outcomes were not necessarily better than those observed with ibrutinib alone, says Awan. It should not be automatically assumed that the addition of a CD20-directed antibody to a BTK inhibitor will lead to longer remissions for patients, adds Awan.

In contrast, data from the CLL11 trial showed that obinutuzumab (Gazyva) outperformed rituximab, says Awan. As such, examining combinations with obinutuzumab made sense to examine in a clinical trial. Some emerging data suggest that there might be a trend toward improved outcomes when obinutuzumab is combined with acalabrutinib (Calquence) and possibly with ibrutinib. The field does not have the right trials to answer that specific question yet, concludes Awan.