Brian T. Hill, MD, PhD, assistant professor, Hematology and Oncology, Cleveland Clinic, discusses recent advances in the treatment of patients with chronic lymphocytic leukemia (CLL).

In contrast to the old way of treating CLL which consisted of chemotherapy and chemoimmunotherapy over and over again with diminishing results, there are now several highly active therapies in this space, Hill says. The challenge for hematologic oncologists now lies in deciding which treatments to use and how to sequence them. Hill argues that there is still a population of patients with CLL who will benefit from chemotherapy, depending on their comorbidities and molecular profile. For relapsed disease and sometimes in the frontline setting, the BTK inhibitor ibrutinib (Imbruvica) has become a standard option, and acalabrutinib (Calquence) is also being explored. This treatment is particularly effective in patients with 17p deletion who are resistant to bendamustine-based therapy.

Beyond BTK inhibitors, researchers now know that venetoclax is highly active in patients with CLL. With proper dose escalation, this agent can be administered safely, Hill says.