Review of Appropriate Therapies for Patients With CLL After Venetoclax Discontinuation
Posted: Tuesday, June 2, 2020
In a large, comprehensive evaluation of therapies after venetoclax discontinuation in patients with chronic lymphocytic leukemia (CLL), a team of investigators concluded that therapeutic selection requires careful consideration of prior novel agent exposure and reasons for treatment discontinuation. Although efficacy data for the use of venetoclax after Bruton’s tyrosine kinase (BTK) inhibitor therapy have been well described, the impetus for this study, published in Clinical Cancer Research, was based upon current limited data after venetoclax discontinuation.
Anthony R. Mato, MD, MSCE, of Memorial Sloan Kettering Cancer Center, New York, and colleagues identified patients with CLL who discontinued venetoclax in the front-line (4%) and refractory settings (96%). Patients received a median of three therapies prior to venetoclax; 40% were BTK inhibitor–naive (n = 130) and 81% were idelalisib-naive (n = 263). To define the study cohort, medical chart review was performed to identify all patients with CLL who discontinued venetoclax-based therapies. Utilizing a standardized case report form, investigators collected data on patients’ pre-venetoclax demographics, disease characteristics, clinical and genetic characteristics, prior therapies, venetoclax dosing, response and survival outcomes, reasons for venetoclax discontinuation, and subsequent therapies.
Of interest, the most common reasons for discontinuation of venetoclax included progression of CLL, adverse events, Richter’s transformation, physician or patient preference, planned cellular therapy, unrelated death, secondary malignancy, and sudden death. The researchers also stressed that the success of the MURANO trial, the recent German CLL14 trial, and other pivotal venetoclax monotherapy phase I to II trials encouraged prescribing physicians to utilize venetoclax (with or without an anti-CD20 monoclonal antibody) because of its favorable efficacy and safety profile earlier in treatment pathways.
Disclosure: For full disclosures of the study author, visit clincancerres.aacrjournals.org.
