Managing chronic lymphocytic leukemia (CLL) can be similar to a chess match, but one that is played for the ultimate stakes.
We need to be careful when considering not only our next move, but also the move after that, and the one after that one.
Dr. Anthony Mato of the University of Pennsylvania consolidates results from many institutions to present what real-world data reveals about the optimal treatment strategy to maximize the longest-term control of our CLL.
Take Away Points:
- Ibrutinib is a good first choice both frontline and in relapsed and refractory patients.
- For a second-line treatment switching from ibrutinib to idelalisib or vice versa is often an effective choice with little chance of having the same side effects and is usually a better choice than chemo-immunotherapy.
- There may be an early signal that venetoclax is a better choice than idelalisib for those who must discontinue ibrutinib.
- Real-world data such as this can be helpful in developing guidelines for optimal management of CLL.
Here is the link to Dr. Mato’s ASH 2016 abstract on the real world study on sequencing therapy entitled Optimal Sequencing of Ibrutinib, Idelalisib, and Venetoclax in CLL: Results from a Large Multi-Center Study of 683 US-Patients
Here is the link to the free editorial from Dr. Mato and his colleagues on the need for real world data in management guidelines.
Below is our interview.
As my friend Wayne Wells has been heard to say: May your path be well chosen.
We are all in this together
Brian Koffman, MD 5/30/17