Danielle Brander, MD, assistant professor of medicine, Duke Cancer Institute, discusses the treatment of patients with relapsed/refractory chronic lymphocytic leukemia (CLL).

Brander says there is debate about which patients with CLL will benefit from chemotherapy versus chemoimmunotherapy. The majority of patients in the relapsed/refractory setting are being transitioned to novel therapies. Currently, patients in the relapsed/refractory setting can receive ibrutinib (Imbruvica) if they did not receive it in the frontline setting, idelalisib (Zydelig) if they had more than 2 prior lines of therapy or are not eligible for other treatments, or venetoclax (Venclexta). In June 2018, venetoclax was granted a full approval by the FDA for the treatment of patients with CLL with or without 17p deletion, following at least 1 prior therapy.

There are multiple targeted inhibitors that are being tested in this population, as well. Clinical trials are investigating next-generation BTK inhibitors such as acalabrutinib (Calquence). In high-risk patients, acalabrutinib will be randomized versus ibrutinib in a phase III trial to evaluate differences in toxicity, Brander says.