Is There a Role for Chemo-Immunotherapy in the CLL Treatment Landscape?

During the 2024 Great Debates & Updates (GDU) Meeting in Hematological Malignancies in New York, John Allan, MD, Weill Cornell Medicine, New York, discusses if there is a role for chemo-immunotherapy in the CLL treatment landscape.

Transcript:

Dr. Allan: I'm John Allan, coming to you from New York City, where I practice at Weill Cornell Medicine, and I'm a CLL lymphoma specialist there.

Lymphoma, Leukemia, & Myeloma Network: Is there a role for chemo-immunotherapy in the treatment of CLL?

Dr. Allan: I think it's a pretty easy answer for me, particularly in this day and age, and that answer is no. No, not in the CLL space.

We have multiple phase 3 clinical trials of targeted agents like Bruton’s tyrosine kinase (BTK) inhibitors going head-to-head, not just against chlorambucil, but against bendamustine-rituximab, against [fludarabine, cyclophosphamide and rituximab] (FCR) showing improved progression-free survival and sometimes even overall survival depending on that regimen being used.

Based on the toxicity profile, which is just dramatically improved with these targeted agents, you get essentially better outcomes with less toxicity. Patients are having unbelievable long-term outcomes and improved overall survival. I've never used chemotherapy for frontline CLL patients in my entire practice. I think that's an important point to note that I still see patients possibly never needing more than maybe 2 classes of drugs in their entire lifetime.

Though, there are high-risk patients we still need to worry about that do break through some of these targeted agents. I think with new drugs and new research that are currently being developed, we can address some of these resistant mechanisms.