Frontline Therapies

Frontline therapy refers to a patient’s first CLL treatment. There are many choices and much to consider. Beyond the safety and effectiveness of the therapy itself, the first treatment selection, much like an opening chess move, can influence the availability and likelihood of success of some follow-up treatments. Most patients will need multiple lines of therapy to enjoy a long and healthy life. Don’t let yourself become overwhelmed or expect to become an expert overnight. With CLL, you almost always have time to learn about the disease, and to identify a CLL expert to help guide the start of your treatment journey. 

Action items for Frontline Therapies

Test Before Treat™

Have appropriate predictive testing done before you begin treatment for CLL. Your life may depend on it!  Appropriate testing can rule out in advance any therapies that are unlikely to work for you. Don’t skip this step! CLL Society’s Test Before Treatliterature was designed to prevent the tragedy of patients being prescribed a therapy that will not work for them, when a simple blood test could have averted this problem. 

Learn to play chess!

Know that the first therapy choice is critically important. Use of certain medications can either increase or limit the success of certain future therapy options. This is like a chess move! Engage in discussion with your treatment team, not only about your first line of treatment, but what your subsequent options might be in light of the first. Knowing well that new drug developments or changes in your health status may influence options. At least rough out a plan B by knowing the indications and success profiles of different treatments for later in your CLL journey. 

Understand frontline treatment options!

Your comorbidities and Test Before Treat™ outcomes, are guides to appropriate treatment choices. Our resources below deliver a basic understanding of the approved medications, how they work, and their side effects. CLL Society frequently posts articles and interviews related to first treatments. Some good search terms to put in our search bar might be Frontline, Firstline, Treatment Naive, or its abbreviation (TN).

 Sometimes a clinical trial is your best course of action. 

Be clear to yourself and inform your treatment team regarding your personal preferences.

Some things to consider: Does oral versus IV medication matter to you? Are there certain side effects that you couldn’t tolerate? Do you care whether the treatment is time-limited or continues until the CLL/SLL progresses or the drug ceases to work? Is there an ongoing pandemic that would make a hospital administered treatment a concern for the immunocompromised? Perhaps you would find the treatment that demonstrates the best overall survival data the most compelling, regardless of the above considerations. Speak up! Engage in discussion of your preferences with your healthcare provider.

Test Before Treat™

Have appropriate predictive testing done before you begin treatment for CLL. Your life may depend on it!  Appropriate testing can rule out in advance any therapies that are unlikely to work for you. Don’t skip this step! CLL Society’s Test Before Treatliterature was designed to prevent the tragedy of patients being prescribed a therapy that will not work for them, when a simple blood test could have averted this problem. 

Learn to play chess!

Learn to play chess!

Know that the first therapy choice is critically important. Use of certain medications can either increase or limit the success of certain future therapy options. This is like a chess move! Engage in discussion with your treatment team, not only about your first line of treatment, but what your subsequent options might be in light of the first. Knowing well that new drug developments or changes in your health status may influence options. At least rough out a plan B by knowing the indications and success profiles of different treatments for later in your CLL journey. 

Understand frontline treatment options!

Your comorbidities and Test Before Treat™ outcomes, are guides to appropriate treatment choices. Our resources below deliver a basic understanding of the approved medications, how they work, and their side effects. CLL Society frequently posts articles and interviews related to first treatments. Some good search terms to put in our search bar might be Frontline, Firstline, Treatment Naive, or its abbreviation (TN).

 Sometimes a clinical trial is your best course of action. 

Be clear to yourself and inform your treatment team regarding your personal preferences.

Some things to consider: Does oral versus IV medication matter to you? Are there certain side effects that you couldn’t tolerate? Do you care whether the treatment is time-limited or continues until the CLL/SLL progresses or the drug ceases to work? Is there an ongoing pandemic that would make a hospital administered treatment a concern for the immunocompromised? Perhaps you would find the treatment that demonstrates the best overall survival data the most compelling, regardless of the above considerations. Speak up! Engage in discussion of your preferences with your healthcare provider.

ADDITIONAL READING

Acalabrutinib plus high-frequency, low-dose subcutaneous rituximab is tolerable and effective. In addition, because it can be administered at home, it is more convenient and can decrease patient infection risk during pandemics. However, while it does control disease, it does not lead to undetectable measurable residual disease (uMRD).
At the American Society of Clinical Oncology (ASCO) Annual Meeting in 2022, Dr. Bill Wierda of MDACC presented the follow-up three-year data of the fixed duration (FD) ibrutinib (I) + venetoclax (V) for first-line (1L) treatment (treatment) of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL).
Chronic Lymphocytic Leukemia (CLL) is a heterogeneous illness with a variable clinical course primarily determined by the disease’s underlying genetics, which is not the same for each affected individual. However, one gene that is highly important in predicting the natural history of CLL and response to chemoimmunotherapy is TP53,
At the American Society of Hematology (ASH) 2021, Dr. Nicole Lamanna, Associate Clinical Professor of Medicine at Columbia University Medical Center, interviewed Dr. Nitin Jain, Associate Professor in the Department of Leukemia at The University of Texas MD Anderson Cancer Center. They discussed early results from an ongoing study
RECENT NEWS

When appropriate, the CLL Society will be posting updates and background information on the present Coronavirus pandemic focusing on reliable primary sources of information and avoiding most of the news that is not directly from reliable medical experts or government and world health agencies.