Dr. Awan on the Role of Chemotherapy in CLL

Farrukh Awan, MD, associate professor, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, discusses the role of chemotherapy in the treatment of patients with chronic lymphocytic leukemia (CLL).

There has been a tremendous explosion of new drugs in CLL that have substantially improved outcomes for patients, says Awan. Novel therapies have reduced the need for chemotherapy. For example, in the phase III Alliance A041202, older patients with treatment-naïve CLL were randomized to receive bendamustine plus rituximab (Rituxan; BR), ibrutinib (Imbruvica), or ibrutinib plus rituximab. The results showed a substantial improvement in progression-free survival (PFS) with ibrutinib versus BR. Additionally, in the phase III E1912 trial, the combination of ibrutinib and rituximab improved PFS and overall survival versus fludarabine, cyclophosphamide, and rituximab in younger patients with newly diagnosed disease.

However, certain subgroups of patients may derive more benefit from chemotherapy versus continuous therapy with ibrutinib, says Awan. For example, patients with mutated IGHV tend to do well with chemotherapy.

With further follow-up, researchers might discover that BTK inhibitors are the preferred treatment in CLL.