Bita Fakhri, MD, MPH, a professor of medicine in the Division of Hematology/Oncology at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses considerations in selecting the optimal treatment in chronic lymphocytic leukemia (CLL).

There are several frontline treatment regimens in CLL, including ibrutinib (Imbruvica), acalabrutinib (Calquence), and the combination of obinutuzumab (Gazyva) and venetoclax (Venclexta), explains Fakhri.

As such, treatment selection is largely a mutual decision between the patient and physician. Both ibrutinib and acalabrutinib are given as continuous therapy as long as the patient tolerates the drug and their disease is responsive. Conversely, obinutuzumab/venetoclax is a time-limited, 12-month regimen that may be more appealing to patients who do not want to be on therapy indefinitely.

The adverse event profiles of these agents should also be considered, says Fakhri. BTK inhibitors are associated with a risk of atrial fibrillation and cardiac dysrhythmias, while obinutuzumab/venetoclax is associated with cytopenia.