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 (A) and ibrutinib (I) are both highly effective Bruton tyrosine kinase (BTK) inhibitors approved for the treatment of chronic lymphocytic leukemia (CLL) and given as continuous treatments until disease progression or unacceptable toxicity.
Ibrutinib and Venetoclax have as we like to say at the CLL Society orthogonal or complementary mechanisms of action. Ibrutinib inhibits chronic lymphocytic leukemia or CLL cells’ proliferation and gets the cancer cells out of their protective niches in the nodes and bone marrow and into the blood stream