When to Retreat, When to Switch in CLL Treatment Decision-Making: Adam Kittai, MD

What happens when the best treatment available for a blood cancer works, and then stops working? What is the next best choice when the data are still catching up to the clinic? Adam Kittai, MD, who serves as director, CLL Program, Perlmutter Cancer Center, and director, Lymphoma Program, Perlmutter Cancer Center - Long Island, at NYU Langone Health, answered these questions and more in a recent interview with The American Journal of Managed Care^® (AJMC^®).

Kittai’s work lives at the intersection of precision medicine and real-world decision-making in chronic lymphocytic leukemia (CLL), a disease where the treatment landscape has shifted dramatically—from chemotherapy to Bruton tyrosine kinase (BTK) inhibitors to venetoclax-based regimens. His clinical lens is sharpened not just by the landmark trials he follows closely, like AMPLIFY (NCT03836261), CLL13 (NCT02950051), and CLL17 (NCT04608318), but by the harder questions those trials have yet to answer.

As he puts it, “We don’t have that 1, 2 study published,” speaking to results that could definitively illustrate how a patient might fare after moving sequentially through a BTK inhibitor and then a venetoclax-based regimen. That gap in the evidence isn’t a reason for despair, however; it’s a reason for nuance. He expects both options to continue performing in the second-line setting, while being candid that diminishing returns are a real and honest concern.

In part 3 of his recent interview with AJMC, he digs into some of the most pressing clinical questions in CLL right now. How should oncologists think about retreatment with the same regimen after a treatment-free interval? When does a triplet like acalabrutinib/venetoclax/obinutuzumab make sense, and for which patients? What does a minimal residual disease–guided approach actually look like in practice? The answer to the latter stems from the work of Matthew Davids, MD, MMSc, out of Dana-Farber.