“It is time to rethink how we treat chronic lymphocytic leukemia (CLL),” said Chadi Nabhan, MD, MBA, FACP, Cardinal Health Specialty Solutions (Chicago, IL) during a session at the Clinical Pathways Congress, where he spoke at length about the shifting landscape of oncology care and the role of clinical pathways.
First, Dr Nabhan explained that the prognostic factors for CLL have changed significantly over the last decade. While there are still the traditional factors such as age, male sex, and tumor load, advances in medical research have revealed that chromosomal abnormalities also play a significant role in determining patient prognosis and predicting survival.
As a result, clinicians have been forced to change how they understand their patients’ circumstances. Where once patients with CLL could be categorized as having either high or good risk, Dr Nabhan said that there is now a third category, which he called “not-so-good” risk. However, a number of new therapies have been released that may offer new opportunities to all patients. Still, physicians will need to be cautious about how they are administering these treatments because the toxicities patients experience may be different from what are reported in clinical trials.
Additionally, failure on one tyrosine-kinase inhibitor does not necessarily mean that patients will not respond to another. In their own study, Dr Nabhan and his colleagues found that progression-free survival could be prolonged when patients were treated with ibrutinib after idelalisib, or idelalisib after ibrutinib.
He concluded by saying that pathways for CLL will need to incorporate all of the complex factors, including the consideration of individual patient chromosomal abnormalities. Further, while a number of patients will benefit from immunotherapies and monoclonal antibodies, chemotherapy is still a viable option for many other patients and should not be ruled out.
