The evolving treatment landscape of chronic lymphocytic leukemia

Luana Schiattone, Paolo Ghia, Lydia Scarfò

Research output: Contribution to journalReview article

Abstract

Purpose of reviewThis review provides guidance in the rapidly changing scenario of chronic lymphocytic leukemia (CLL) treatment. New studies as well as updates of other seminal ones have been recently presented and are likely to change the management of patients with CLL in everyday clinical practice.Recent findingsKinase inhibitors (e.g. ibrutinib and idelalisib) have transformed the treatment paradigm in CLL in both front-line and relapsed/refractory patients. Longer follow-up data are now available supporting the safety of ibrutinib and the continuous administration required per current label. Novel studies show the superiority of the drug alone or in combination with monoclonal antibodies compared with standard chemoimmunotherapy. The combination of venetoclax and obinutuzumab (treatment-naïve, only in United States) or rituximab (relapsed/refractory) has granted approval from the regulatory authorities in United States and Europe, based on phase 3 randomized studies. These novel chemo-free combinations allow for fixed-duration treatment and undetectable minimal residual disease. Novel targeted strategies including second and third generation BTK and PI3K inhibitors are currently under investigation and promise to further improve the CLL treatment armamentarium. The chimeric-antigen receptor (CAR) T cells are coming to the stage with promising efficacy and new challenges.SummaryA bright chemo-free era for CLL patients is just around the corner. A deep knowledge of currently available evidences is key to tailor treatment choice and optimize long-term tolerability and disease control. Fixed-duration combinations are investigated to allow treatment holidays and avoid the emergence of resistant clones under the selective pressure of continuous treatment.

Original languageEnglish
Pages (from-to)568-573
Number of pages6
JournalCurrent Opinion in Oncology
Volume31
Issue number6
DOIs
Publication statusPublished - Nov 1 2019

Keywords

  • chemoimmunotherapy
  • chronic lymphocytic leukemia
  • minimal residual disease
  • targeted agents

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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