At the 24th annual Congress of the European Hematology Association(EHA), Amsterdam, NL, use of ibrutinib in early and late chronic lymphocytic leukemia (CLL) was discussed. On Friday 14 June 2019 session, Arnon P Katerfrom the University of Amsterdam, Amsterdam, NL, presented on the safety of venetoclax and ibrutinib in patients with relapsed/refractory (R/R) CLL from the phase II VISION/ HOVON 141 (HOV141) trial. 1While Petra Langerbeinsfrom the University of Cologne, Köln, DE, on Sunday 16 March 2019, discussed the results of phase III CLL12 trial on ibrutinib versusplacebo in patients with asymptomatic, treatment-naive early-stage CLL. 2

Ibrutinib is a therapy designed to target Bruton’s tyrosine kinase, which is essential for the survival of CLL leukemia cells. Therefore, unlike standard chemotherapy, ibrutinib is directed specifically against cancer cells and should not affect normal cells. Ibrutinib-based therapy is already a standard of care for R/R patients with CLL and is becoming popular as a frontline for high risk or older patients. However, questions remain regarding its toxicity profile and its efficacy for asymptomatic patients with intermediate to very high risk of progression.

Ibrutinib in indolent disease

Currently, it is not clear whether patients with inactive indolent CLL would benefit from early treatment. The placebo-controlled, double-blind phase 3 study, CLL12, aimed to assess whether ibrutinib, would benefit asymptomatic, treatment-naive patients with increased risk of progression, in terms of improved efficacy with low toxicity.