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Determining Optimal CLL / SLL Therapy: Ibrutinib, Acalabrutinib and Zanubrutinib

Opinion
Video

Medical experts illustrate the impact of combination therapy for treatment of CLL and SLL.

This is a video synopsis/summary of a Peer Exchange involving Ryan Haumschild, PharmD, MS, MBA, CPEL; Tara Graff, DO, MS; Ryan Jacobs, MD; Deborah Stephens, DO; and Jennifer Woyach, MD.

The group discusses how next-generation Bruton tyrosine kinase (BTK) inhibitors like acalabrutinib and zanubrutinib are changing frontline treatment approaches compared withthe previously standard ibrutinib. For patients already on and tolerating ibrutinib well, continuing this therapy is reasonable. However, for most new patients, providers are now prescribing next-generation BTK inhibitors due to improved safety. There are some unique situations where ibrutinib may still be preferred, like in clinical trials, if T-cell dysfunction needs correction, or prior to chimeric antigen receptor (CAR) T-cell therapy.

The group discusses ongoing research into combination therapies with BTK inhibitors to improve efficacy in treating chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). Combinations being explored include acalabrutinib plus obinutuzumab andall-oral combinations like ibrutinib plus venetoclax. More complex combinations involving CAR-T therapy and bispecific antibodies are also on the horizon. The goal is to manipulate the immune system to maximize efficacy, improve quality of life, and work toward a potential cure. However, added toxicities from combination regimens need to be considered as well. Ultimately more comparative data arestill needed to determineoptimal combination approaches.

 

Video synopsis is AI-generated and reviewed by AJMC® editorial staff.

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