Dr Jeff Sharman Discusses Standard of Care for CLL Based on Treatment Setting

Jeff Sharman, MD, medical oncologist, Willamette Valley Cancer Institute and Research Center; medical director, The US Oncology Network, discusses the standard of care for chronic lymphocytic leukemia (CLL) in the first-line setting and the relapsed setting.


How does the standard of care for CLL differ based on treatment setting?

Chronic lymphocytic leukemia is a slow growing disease. It takes a long time for many patients to have their disease grow to a point where it needs treatment, and when patients need their first-line therapy, there are a lot of choices out there, and they’re broadly divided into a chemoimmunotherapy approach or a targeted agent approach.

Just later today, we’re going to see information in the plenary session of the meeting that that exact question is being addressed in a study where patients get either ibrutinib, ibrutinib and rituximab, or bendamustine and rituximab. The findings of the study, and this is kind of somewhat an older population, is that the progression-free survival would appear to favor those patients treated with ibrutinib compared to chemoimmunotherapy.  

But if you dive a little bit deeper and look at the different types of subgroups, and as we begin to talk about personalized medicine, there are some markers where the benefit of ibrutinib over chemoimmunotherapy is very clear, there are other groups where you can make an argument for a fixed-duration chemoimmunotherapy-based approach.

When you get to the relapsed setting, it really does tend to favor more of the novel targeted therapies, such as ibrutinib or venetoclax compared to chemotherapy-based treatment.
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