The Role of BTKi Monotherapy for CLL
Ricardo D. Parrondo, MD, discusses monotherapy and combination BTKi therapy options for chronic lymphocytic leukemia, noting that the decision depends on patient preferences and disease risk.
Asher A. Chanan-Khan, MD, MBBS: What are your thoughts on data pertaining to mono vs combination therapy in the first-line setting?
Ricardo D. Parrondo, MD: There are data with both monotherapy and combination therapy. Again, I think all of it comes down to patient preference and disease risk. A patient who desires all oral therapy, if they’re OK with continuous therapy, there are robust data [focusing on the use of] multiple, single-agent BTK [Bruton tyrosine kinase] inhibitors until disease progression. For patients who desire time-limited therapy, all oral, there are emerging data with BTK inhibitors and BCL-2 inhibitors for a limited duration of treatment. And for patients who are OK with IV [intravenous] infusions there are strong data with CD20 monoclonal antibody and venetoclax in first-line CLL [chronic lymphocytic leukemia]. Another factor that is important here is the patient’s risk. Again, I come back to patients with deletion 17p or p53 mutations. I like to treat those patients with a BTK inhibitor and single agent BTK inhibitor until disease progression. We know that the addition of obinutuzumab to acalabrutinib does not really improve the outcomes for patients with deletion 17p, but it does improve outcomes for patients with standard risk or low-risk CLL without deletion 17p and then even with a doublet of BTK inhibitor and BCL-2 inhibitor, time-limited patients with p53 mutation, the PFS [progression free survival] is inferior compared with patients without p53 mutation. So those are the factors that I take into account when considering mono vs doublet therapy.
Asher A. Chanan-Khan, MD, MBBS: Fantastic. I agree with you. I think these are important considerations as we’re treating.
