Dr Seymour on the Role of Mutational Profiling in CLL

John Seymour, MBBS, FRACP, PhD, director, Department of Hematology, the Peter MacCallum Cancer Centre, medical oncologist, Hematology Department, the Royal Melbourne Hospital, shared considerations for community oncologists regarding the role of mutational profiling in the treatment of patients with chronic lymphocytic leukemia (CLL).

The CLL treatment armamentarium has expanded over the past decade, with multiple targeted agents now available for this patient population, Seymour begins. However, he explains that understanding a the mutational profile of an individual patient’s disease is crucial to inform treatment decision-making.

Seymour notes that TP53 and IGHV mutational status play a pivotal role in informing treatment decisions and optimizing patient outcomes in both the short and long term. He highlights that the integration of mutational profiling into routine clinical practice is essential. For example, TP53 mutations or deletions, which are associated with poorer prognoses and resistance to chemoimmunotherapy, may steer clinicians toward the use of targeted therapies, such as BTK inhibitors or BCL-2 inhibitors, Seymour says.

Seymour also emphasizes the importance of involving patients in the decision-making process, ensuring they are fully informed about the implications of each treatment option. This includes discussing the logistics of therapy, such as the frequency of visits, monitoring requirements, and potential impact on their quality of life, he adds.

Through effective education, Seymour notes that patients can better understand pros and cons between different therapies; for example, some regimens may be given as continuous therapy, and others could feature time-limited treatment. He explains that these differences need to be discussed with patients to help them make informed decisions that align with their personal preferences and lifestyle.

A personalized approach to CLL management through the integration of both biological insights and patient involvement is useful, he continues. This strategy enhances adherence to treatment and allows for tailoring therapeutic choices to the specific disease characteristics and personal needs of each patient. By aligning treatment plans with patient preferences and the biological profile of their disease, clinicians can achieve improved outcomes and greater patient satisfaction, particularly in the community oncology setting, Seymour concludes.