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Updated CLL Tool
CLL Is Evolving and the Treatment Decision Support Tool Is Keeping Pace

Released: November 13, 2019

Expiration: November 11, 2020

Farrukh Awan
Farrukh Awan, MD, MS
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In 2018, 4 colleagues and I developed an online interactive tool for chronic lymphocytic leukemia (CLL) to help clinicians sort through treatment decisions for various patient case scenarios. Over the past year, we have seen results from several major landmark trials that contributed to significant changes and improvements in the treatment paradigm of patients with CLL in both the newly diagnosed and relapsed/refractory settings. With the shift from chemoimmunotherapy to targeted therapies in both disease settings, my colleagues and I incorporated these new findings into the CLL tool and the updated version was launched recently.

Recent Practice-Changing Clinical Trials in CLL
The treatment landscape of CLL has undergone major transformation in the last year due to positive results from several landmark studies. In the newly diagnosed setting, we saw data from the phase III A041202, E1912, and iLLUMINATE trials that further established ibrutinib as a preferred frontline therapy. These findings also provided compelling evidence of limited utility of chemoimmunotherapy for the vast majority of patients with CLL. Venetoclax‑based regimens offer an attractive alternative to ibrutinib in the form of a finite duration of treatment. Recent exciting data from the phase III CLL14 trial led to the approval of venetoclax plus obinutuzumab as first-line treatment of CLL.

In the relapsed/refractory setting, we have new data from the phase III ASCEND trial of acalabrutinib in patients with previously treated CLL as well as the phase III DUO trial of duvelisib in relapsed/refractory CLL. Based on the DUO data, duvelisib was approved for treating relapsed/refractory CLL after at least 2 previous therapies. Although acalabrutinib is not yet approved by the FDA in CLL, it has received category 1 recommendation in the current NCCN guidelines for treating relapsed/refractory CLL.

Updates to the Online Treatment Decision Support Tool
Based on these new data, we included a consideration of venetoclax plus obinutuzumab as a frontline treatment option along with ibrutinib for patients with newly diagnosed CLL in the updated tool. In addition, we added questions to help guide clinicians to select the optimal first-line therapy for individual patients. In the relapsed/refractory setting, both acalabrutinib and duvelisib can be considered as new treatment options. Moreover, we expanded the 2019 tool to include the third-line setting so that clinicians can get expert insights on how to treat patients who have failed multiple previous therapies.

With these updates, we hope that the CLL tool will provide clinicians with a useful resource to quickly see what experts in CLL care would recommend for specific patient case scenarios and give them a convenient way to look at opinions from 5 experts in the field. Of course, besides expert recommendations, clinicians also need to consider other factors including individual patient preferences, treatment goals, comorbidities, and reimbursement when making treatment decisions for their patients. It is our hope that this online tool will be updated on a regular basis so that our recommendations include consideration of emerging data and new therapies. I encourage you to try this updated CLL tool and share it with your colleagues.

Your Thoughts
What are your questions and suggestions regarding the updated treatment decision support tool for CLL? Please answer the polling question and share your thoughts in the discussion box below.