Dr. Kahl on Frontline Therapy Selection in CLL

Brad Kahl, MD, professor in the Department of Medicine, Washington University School of Medicine, Siteman Cancer Center, discusses frontline therapy selection in chronic lymphocytic leukemia (CLL).

Ibrutinib (Imbruvica) is a potential frontline therapy for patients with CLL. It is a chronic daily therapy, which patients can be on for years, explains Kahl. If the patient is 56-years-old, and particularly if they have mutated disease, a 6-month course of chemotherapy may be better used upfront so that ibrutinib can be saved for later, says Kahl.

Kahl saw a 75-year-old patient who was deciding whether to proceed with ibrutinib or the combination of bendamustine and rituximab (Rituxan). Although the patient could have tolerated the combination, Kahl explains that it’s a more challenging regimen to tolerate as a patient gets older. When thinking about sequencing, it may be more beneficial to reserve ibrutinib for later lines of therapy when the patient is older and less fit. However, not all physicians subscribe to this rationale, he adds.