Dr Dorritie on the Management of Untreated and Relapsed/Refractory CLL

“In the newly diagnosed setting, [care for CLL] has really changed with the results from studies like AMPLIFY and also the ELEVATE-TN population. Essentially, at this point, we've now had evidence both from AMPLIFY and from ELEVATE-TN that directed therapies.”

Kathleen A. Dorritie, MD, a hematologist/medical oncologist at the University of Pittsburgh Medical Center Hillman Cancer Center, detailed differing care among patients with newly diagnosed chronic lymphocytic leukemia (CLL) compared with patients with relapsed/refractory CLL who have received multiple lines of therapy.

The difference in care for patients with CLL in the newly diagnosed setting has changed following data from the phase 3 AMPLIFY trial (NCT03836261) and phase 3 ELEVATE-TN trial (NCT02475681), Dorritie began.

Of note, the AMPLIFY trial evaluated fixed-duration acalabrutinib (Calquence) plus venetoclax (Venclexta) vs acalabrutinib plus venetoclax and obinutuzumab (Gazyva) vs chemoimmunotherapy for the treatment of patients with untreated CLL.

Additionally, the ELEVATE-TN study investigated acalabrutinib with or without obinutuzumab in patients with untreated CLL. In particular, the study compared acalabrutinib plus obinutuzumab with acalabrutinib monotherapy and with chlorambucil plus obinutuzumab.

Specifically, the implementation of BTK inhibitors and venetoclax, a BCL2 inhibitor, as upfront treatment is becoming the standard of care in treatment-naive CLL, Dorritie continued. She noted that now, fewer patients are treated with only an upfront chemotherapy regimen for untreated CLL. Both the AMPLIFY and ELEVATE-TN studies have demonstrated that patients who are treated with targeted therapies showed improved outcomes vs those treated with standard chemoimmunotherapy, she added.

Furthermore, in the relapsed/refractory CLL setting, a remaining question includes how subsequent therapies should be sequenced, which requires additional information, such as what patients were previously treated with, how they responded to those therapies, and the toxicities they experienced related to a specific treatment, Dorritie emphasized. These factors ultimately and collectively guide the next treatment option for this patient population, she concluded.