New first-line treatments for chronic lymphocytic leukemia

Christina Cebrian
Irene Riera (Video)
Clinical studies conducted on leukemia chronic lymphocytic has opened the door to new therapeutic alternatives that are more specific and aimed at selectively eliminating tumor lymphocytes and attempting to modify disease progression.

Clinicians treating this pathology note an increase in the effectiveness of new treatment strategies. In particular, in some cases, progression-free survival (PFS) and even overall survival (OS) have increased, as the researchers explained. iHealth That Dr. Maria Angeles Medina, Coordinator of the Hematology and Hemotherapy Unit at the Costa del Sol Hospital in Marbella and one of the coordinators of the XII Conference on Lymphoid Neoplasia 2024, recently organized in Cordoba by Johnson & Johnson Innovative Medicine.

In addition, the hematologist emphasizes that new targeted drugs They are much better tolerated because they are less toxic compared to the immunochemotherapy regimens (traditional chemotherapy and monoclonal antibodies) that have been used so far.

What are the results observed after applying new treatment strategies for chronic lymphocytic leukemia?
With these new treatments, we are seeing increased effectiveness. That is, we were able to increase patient survival, both PFS and OS in some cases. In general, this results in much better tolerability of the treatment regimens because they are less toxic, so they actually achieve better health outcomes when compared to the previous results that these patients received.

In the last decade, new targeted drugs directed against CLL tumor lymphocytes have been approved, and chemotherapy-free treatment regimens have become possible.

How has the approach to treating CLL changed with the use of non-chemotherapy regimens such as targeted drugs?
Over the last 10 years, the treatment of CLL has changed dramatically. Previously, regimens with immunochemotherapy (traditional chemotherapy and monoclonal antibodies) were used. In the last decade, given that knowledge about this disease has become much deeper and new targeted drugs have been approved that are directed against the tumor lymphocytes of CLL, it has become possible to use treatment regimens without chemotherapy. These are drugs that are directed at tumor cells, and this has radically changed the treatment of patients.

What advantages do these treatments have for patients compared to traditional treatments such as immunochemotherapy?
They have many advantages. First of all, efficiency. These are more effective drugs that in some cases increase PFS and OS, which gives us better results. Secondly, these are much safer and less toxic drugs, so the patient will live longer and live better. This means you’ll have fewer hospital visits, you’ll have fewer side effects, and you’ll be able to balance your work and family life much better with everything your illness entails. In this case, the patient will also have much less feeling of illness.

Older patients also benefit from this type of therapy as these treatments are effective and can be prescribed to older patients.

How do very elderly patients benefit from this therapeutic innovation?
Older patients also benefit from this type of therapy because these treatments are effective and can be given to older patients. The reason is that they are less toxic and many of them are given orally, so older patients will be additional candidates for this treatment, which is often time-limited. We also already have combinations of treatments that are time-limited and fixed-duration, which also allow them to be used in older patients with significant safety.

What problems does the approach to the treatment of CLL pose in elderly patients with other concomitant diseases and primary treatment?
What happens with older patients is that they have comorbidities, so they are taking other medications to treat those comorbidities. In that sense, we have to be careful about choosing the treatment that is best for these CLL patients, so that it is compatible with the other treatments that the patient is already taking. We also have to be careful that there are no toxicities or interactions that make it impossible to use both types of treatment. All of that is a challenge that we face, but fortunately, strategies are being developed to ensure that these patients are treated well.

Currently, there are still many clinical trials underway that will answer many unresolved questions about new combinations and treatment strategies for chronic lymphocytic leukemia.

Is it possible to create personalized medicine for each type of CLL patient? What is needed to achieve this goal?
We must achieve precision medicine for all diseases, individualized medicine for each type of patient so that we can provide the safest but also the most effective treatment.

We have to combine both things, and to do that we need to know well what the risk is for the patient, what the biological risk is, what the cytogenetic and molecular changes are that define the disease, and to know what all the circumstances are that accompany it, such as other comorbidities and other treatments that are being given to the patient.

Finally, we must know the social circumstances of each patient. That is, can you go to the hospital, do you have family support, etc. All of this will determine the type of treatment we can best tailor to the patient. It will be like making a custom suit for a patient.

What tasks does individualization of treatment pose, taking into account the characteristics of the disease and the patient himself? How can these problems be overcome?
There are many things to know about CLL because it is a heterogeneous disease and we need to know the risk of each patient. In addition, there are still many clinical trials that will answer many questions about new combinations and treatment strategies that we do not yet have answers to. So the fundamental challenge is to understand the risk of the disease well and continue to delve into the data from studies that are not yet complete.

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