Dr Burke on the Assessment of Barriers to Initiating Venetoclax-Based Regimens for CLL

“Most providers and patients tend to prefer BTK inhibitors, which are given indefinitely, over venetoclax-based, fixed-duration therapy. This preference has led to interest in understanding the barriers providers encounter with the latter option and the strategies they employ to overcome these challenges in their practices."

John M. Burke, MD, hematologist, medical oncologist, Rocky Mountain Cancer Centers, discusses the barriers to initiating venetoclax (Venclexta)-based regimens for chronic lymphocytic leukemia (CLL) and strategies for overcoming these challenges. These insights were derived from a survey of community-based health care practitioners (HCPs) conducted in 2024. Findings from the survey were presented at the 2024 ASH Annual Meeting.

Burke explains that fixed-duration venetoclax in combination with obinutuzumab has been shown to elicit deep, durable responses in the frontline setting.. However, this regimen remains less commonly utilized compared with indefinite therapy with a covalent BTK inhibitor. The survey revealed several barriers to initiating venetoclax-based regimens, including concerns about tumor lysis syndrome (TLS), logistical complexities associated with frequent office visits, and the timely turnaround of laboratory tests required during venetoclax ramp-up, Burke explains.

TLS management was identified as a primary concern, as this requires close monitoring and education of both patients and staff, he continues. Burke highlights the importance of addressing these issues through proactive measures, such as providing detailed treatment schedules, ensuring rapid laboratory test processing, and leveraging multidisciplinary care teams to streamline patient logistics. Social workers and financial counselors also play a critical role in supporting patients throughout treatment initiation, he adds.

Burke emphasizes that most surveyed HCPs have implemented best practices to mitigate these challenges effectively. Educational initiatives for both patients and staff were commonly employed to enhance understanding of potential risks and adherence to treatment schedules. Additionally, resources like treatment calendars and TLS management protocols were widely used to facilitate the safe initiation of venetoclax therapy.

Despite these efforts, Burke notes that BTK inhibitors remain the more frequently prescribed first-line treatment for CLL. He attributes this to both patient and provider preference, underscoring the importance of shared decision-making and patient education in expanding the use of venetoclax-based regimens. Efforts to address these barriers continue, Burke concludes.