Richard R. Furman, MD, Morton Coleman, M.D. Distinguished Associate Professor of Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, discusses the available agents that have shown promise for patients with chronic lymphocytic leukemia (CLL).

The 3 most exciting and important agents in the CLL landscape include ibrutinib (Imbruvica), venetoclax (Venclexta), and obinutuzumab (Gazyva). Although ibrutinib is well tolerated most of time, there are a few patients who have contraindications to it, Furman explains. This mainly includes patients who have bleeding risks or atrial fibrillation. In these cases, venetoclax and obinutuzumab are appropriate alternatives. For patients who also don’t wish for intravenous infusions or are concerned about tumor lysis risks, venetoclax or obinutuzumab can be used.

These 3 therapies are able to induce long-term and deep remissions in patients, Furman adds. While ibrutinib can have good outcomes at 5 years, it takes a long time to induce a deep response, he says. In patients with potential indication of either Richter’s transformation or developing a resistance to ibrutinib, they may have better outcomes and tolerability with venetoclax.