Chemoimmunotherapy or BTK inhibition for patients with CLL

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Published: 20 Jun 2019
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Dr Othman Al-Sawaf - University of Cologne, Cologne, Germany

Dr Othman Al-Sawaf speaks to ecancer at the 2019 European Hematology Association (EHA) Annual Meeting about two different treatments for CLL.

He explains that the future of treatment will be to decide when it is necessary to use chemoimmunotherapy or BTK inhibition.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.


In general we have reached now a status in CLL research over a couple of the last years where we have seen that two different treatment paradigms have evolved. We’ve now seen that chemoimmunotherapy has been challenged with BTK inhibition as a continuous monotherapy. So several trials, particularly last year, have shown that ibrutinib monotherapy is at least as effective or even more effective than chemoimmunotherapy in several groups of CLL patients. On the other hand, we’ve seen now that we can also have good efficacy in chemotherapy free regimens with fixed duration like venetoclax obinutuzumab. So we now have this paradigm of continuous monotherapy with high efficacy but with no MRD negativity, but still very good responses, and on the other hand we’ve seen that we can do also fixed duration therapy with high levels of MRD negativity and also have, at least for the moment, good responses and good lasting remissions.

So we have these two treatment paradigms and the next major step in CLL research will be to compare these because they are so crucially different for patients and for physicians when they are managing these patients. This will be the next undertaking that has to be done in the CLL community and that we are currently working on – to do a randomised comparison of continuous monotherapy versus fixed duration therapy and see whether they are similar in efficacy, whether there are differences in tolerability, whether there are differences in patient preference. All of that has to be shown now in the next steps to consolidate the large successes we’ve made in CLL research in the last years.