Is Chemoimmunotherapy for CLL on Life Support? (Point- Counterpoint)
While chemoimmunotherapy as treatment for CLL is not dead, its role in upfront treatment is clearly approaching the need for life support. This session will address whether chemoimmunotherapy is still a viable option for upfront patients who need treatment (Full code) or should not continue to be utilized in this patient population (DNR- do not resuscitate).
Chemoimmunotherapy with regimens such as Fludarabine cyclophosphamide and rituximab or bendamustine and rituxumab has been the backbone of initial treatment for patients with chronic lymphocytic leukemia who need to be treated and are eligible for chemotherapy. Complete remissions with prolonged treatment free intervals and achievement of MRD negativity can be achieved in with these regimens. While not curative, these regimens have led to longer survival in successive studies in eligible patients.
However, the introduction of more targeted oral agents such as Ibrutinib and venetoclax and the significant responses in patients who are relapsed and refractory to chemoimmunotherapy have led to these agents being tested in upfront studies compared to chemoimmunotherapy in several large randomized trials presented at this meeting and others over the last year and recently published. These studies, which will be discussed in detail during this session, have shown that the targeted agents have progression free but no overall survival benefit as yet over chemoimmunotherapy.
This has changed paradigms of initial treatment for patients with CLL leading to wider use of targeted agents upfront. While benefits are seen, these drugs do have their own toxicity profiles and as of the current studies, need to be continued indefinitely until progression or toxicity, whereas the chemoimmunotherapy regimens are given for a defined time period leading in a substantial portion of patients having a treatment free interval.
This session will discuss the fate of chemoimmunotherapy in the initial treatment of patients with CLL.
Dr. Susan O’Brien will discuss the data to support the continued use of chemoimmunotherapy in the upfront patients with CLL or, in the words of the great philosopher Monty Python, “I am not dead yet.”
Dr. Stephan Stilgenbauer will discuss the data that supports “pulling the plug” on chemoimmuntherapy for CLL.
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