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

There have been a lot of changes in the treatment options for patients with CLL, says Brander, both in the frontline and relapsed/refractory settings. In frontline, Brander says that much of the effort in the past few years has gone towards identifying patients who may still benefit long-term from chemoimmunotherapy. These are often patients who are young, have a favorable risk indicated by an IGHV-mutation, and no high-risk deletion 11q or 17p. Patients who match this profile can experience 10- to 12-year remissions from frontline therapy with fludarabine-cyclophosphamide-rituximab (Rituxan). Additionally, there may be patients with favorable risk who might be older who may experience a meaningful remission from frontline chemotherapy such as bendamustine and rituximab.

The only FDA-approved targeted agent for the frontline treatment of patients with CLL is ibrutinib (Imbruvica). Recently, a study looking at long-term 5-year follow-up of a cohort of patients who were mainly frontline showed that patients who were not high-risk had very low progression-free survival with ibrutinib.