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Chemotherapy-free frontline therapy for CLL: is it worth it?
- Source :
- Hematology Am Soc Hematol Educ Program
- Publication Year :
- 2020
-
Abstract
- The treatment of chronic lymphocytic leukemia (CLL) embodies one of the great success stories in translational research, with the development of therapies aimed at disrupting crucial pathways that allow for the survival and proliferation of the malignant clone. The arrival of targeted agents into our armamentarium, along with the advent of novel monoclonal antibodies that can achieve deeper remissions, has steered the field to a new treatment paradigm. Given the panoply of therapeutic options available, the question arises whether chemotherapy still has a role in the management of CLL. The novel targeted agents, which include the Bruton’s tyrosine kinase inhibitors, ibrutinib and acalabrutinib, along with the B-cell lymphoma-2 inhibitor, venetoclax, are highly effective in achieving a response with improved remission duration and survival, particularly in high-risk patients. Despite this major progress, the new agents bring a unique set of toxicities unlike those associated with cytotoxic chemotherapy. There is a paucity of head-to-head comparisons among all of the novel agents, because their approval was based on randomization against traditional chemoimmunotherapeutic regimens. Parallel to the increase in the number of available targeted agents, there has been a significant improvement in quality of life and life expectancy of the patients with a CLL diagnosis over the last decade. Our review will examine whether “chemotherapy-free” frontline treatment approaches are worth the associated risks. Our goal is to help identify optimal treatment strategies tailored to the individual by reviewing available data on monotherapy vs combination strategies, depth of response, treatment duration, and potential toxicities.
- Subjects :
- Oncology
Male
medicine.medical_specialty
medicine.medical_treatment
Chronic lymphocytic leukemia
Translational research
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Quality of life
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
A Map for the Changing Landscape of CLL
Chemotherapy
Sulfonamides
business.industry
Venetoclax
Hematology
Middle Aged
medicine.disease
Bridged Bicyclo Compounds, Heterocyclic
Leukemia, Lymphocytic, Chronic, B-Cell
Leukemia
chemistry
030220 oncology & carcinogenesis
Ibrutinib
Pyrazines
Benzamides
Acalabrutinib
business
Rituximab
030215 immunology
Subjects
Details
- ISSN :
- 15204383
- Volume :
- 2020
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Hematology. American Society of Hematology. Education Program
- Accession number :
- edsair.doi.dedup.....781b5b5448f3a50cbde51921a3406e51