Dr. Fakhri on the Use of PI3K Inhibitors in Relapsed/Refractory CLL

Bita Fakhri, MD, MPH, assistant professor of medicine in the Division of Hematology/Oncology at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the use of PI3K inhibitors in relapsed/refractory chronic lymphocytic leukemia (CLL).

PI3K inhibitors are available to patients with relapsed/refractory CLL, says Fakhri. For example, the combination of duvelisib (Copiktra) and ofatumumab (Arzerra) can be offered as a sterile option for patients with relapsed/refractory disease. The other PI3K inhibitor, which has been approved for use in patients with relapsed/refractory CLL is idelalisib (Zydelig). The agent was evaluated in combination with rituximab (Rituxan) compared with rituximab plus placebo and showed clear superiority, says Fakhri.

However, the toxicity profile of PI3K inhibitors can be a challenge. At 2 years, 40% of patients are not able to tolerate these agents, primarily because of autoimmune complications, such as colitis, pneumonitis, and hepatitis, says Fakhri. However, if PI3K inhibitors demonstrate equal utility as time-limited therapy, their role in the field could expand, concludes Fakhri.