1L Therapy

CE / CME

Individualizing Frontline Therapy for Patients With Chronic Lymphocytic Leukemia: Putting Evidence Into Practice

Pharmacists: 0.75 contact hour (0.075 CEUs)

Physicians: Maximum of 0.75 AMA PRA Category 1 Credit

Nurses: 0.75 Nursing contact hour

Released: April 19, 2022

Expiration: April 18, 2023

Nichole Fisher
Nichole Fisher, RN, BSN
Anthony J Perissinotti
Anthony J Perissinotti, PharmD, BCOP
Jennifer A. Woyach
Jennifer A. Woyach, MD

Activity

Progress
1
Course Completed
Reference

  1. National Comprehensive Cancer Network. Clinical practice guidelines in oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. v.2.2022. nccn.org. Accessed April 8, 2022.
  2. Thompson PA, Tam CS, O'Brien SM, et al. Fludarabine, cyclophosphamide, and rituximab treatment achieves long-term disease-free survival in IGHV-mutated chronic lymphocytic leukemia. Blood. 2016;127:303-309.
  3. Fischer K, Bahlo J, Fink AM, et al. Long-term remissions after FCR chemoimmunotherapy in previously untreated patients with CLL: updated results of the CLL8 trial. Blood. 2016;127:208-215.
  4. Ibrutinib [prescribing information]. Sunnyvale, CA: Pharmacyclics, LLC; 2020.
  5. Burger JA, Tedeschi A, Barr PM, et al. Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia. N Engl J Med. 2015;373:2425.
  6. Barr PM, Owen C, Robak T, et al. Up to 8 years follow-up from RESONATE-2: first-line ibrutinib treatment for patients with chronic lymphocytic leukemia. Blood Adv. 2022;[Epub ahead of print].
  7. Sharman JP, Mato AR, Keating MJ. Ibrutinib for chronic lymphocytic leukemia. N Engl J Med. 2016;374:1592-1593.
  8. Shanafelt TD, Wang XV, Kay NE, et al. Ibrutinib-rituximab or chemoimmunotherapy for chronic lymphocytic leukemia. N Engl J Med. 2019;381:432-443.
  9. Shanafelt TD, Wang V, Kay NE, et al. Ibrutinib and rituximab provides superior clinical outcome compared to FCR in younger patients with chronic lymphocytic leukemia (CLL): extended follow-up from the E1912 trial. Presented at: 2019 American Society of Hematology Annual Meeting; December 7-10, 2019. Abstract 33.
  10. Woyach JA, Ruppert AS, Heerema NA, et al. Ibrutinib regimens versus chemoimmunotherapy in older patients with untreated CLL. N Engl J Med. 2018;379:2517-2528.
  11. Woyach JA, Ruppert AS, Heerema NA, et al. Long-term results of Alliance A041202 show continued advantage of ibrutinib-based regimens compared with bendamustine plus rituximab (BR) chemoimmunotherapy. Presented at: 2021 American Society of Hematology Annual Meeting; December 11-14, 2021. Abstract 639.
  12. Ruppert AS, Booth AM, Ding W, et al. Adverse event burden in older patients with CLL receiving bendamustine plus rituximab or ibrutinib regimens: Alliance A041202. Leukemia. 2021;35:2854-2861.
  13. Mato AR, Nabhan C, Thompson MC, et al. Toxicities and outcomes of 616 ibrutinib-treated patients in the United States: a real-world analysis. Haematologica. 2018;103:874-879.
  14. Shirley M. Bruton tyrosine kinase inhibitors in B-cell malignancies: their use and differential features. Target Oncol. 2022;17:69-84.
  15. Project Orbis: FDA approves acalabrutinib for CLL and SLL. fda.gov/drugs/resources-information-approved-drugs/project-orbis-fda-approves-acalabrutinib-cll-and-sll. Accessed April 8, 2022.
  16. Sharman JP, Egyed M, Jurczak W, et al. Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzumab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, phase 3 trial. Lancet. 2020;395:1278-1291.
  17. Sharman JP, Egyed M, Jurczak W, et al. Efficacy and safety in a 4-year follow-up of the ELEVATE-TN study comparing acalabrutinib with or without obinutuzumab versus obinutuzumab plus chlorambucil in treatment-naïve chronic lymphocytic leukemia. Leukemia. 2022;[Epub ahead of print].
  18. Byrd JC, Hillmen P, Ghia P, et al. First results of a head-to-head trial of acalabrutinib versus ibrutinib in previously treated chronic lymphocytic leukemia. Presented at: 2021 American Society of Clinical Oncology Annual Meeting; June 4-8, 2021. Abstract 7500.
  19. Acalabrutinib [prescribing information]. Gaithersburg, MD: AstraZeneca UK Limited; 2022.
  20. Sharma S, Pepin X, Burri H, et al. New acalabrutinib formulation enables co-administration with proton pump inhibitors and dosing in patients unable to swallow capsules (ELEVATE-PLUS). Presented at: 2021 American Society of Hematology Annual Meeting; December 11-14, 2021. Abstract 4365.
  21. FDA approves venetoclax for CLL and SLL. fda.gov/drugs/resources-information-approved-drugs/fda-approves-venetoclax-cll-and-sll. Accessed April 8, 2022.
  22. Fischer K, Al-Sawaf O, Bahlo J, et al. Venetoclax and obinutuzumab in patients with CLL and coexisting conditions. N Engl J Med. 2019;380:2225-2236.
  23. Al-Sawaf O, Zhang C, Robrecht S, et al. Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 4-year follow-up analysis of the randomized CLL14 study. Presented at: 2021 European Hematology Association Congress; June 9-17, 2021. Abstract S146.
  24. Allan JN, Shanafelt T, Wiestner A, et al. Long-term efficacy of first-line ibrutinib treatment for chronic lymphocytic leukaemia in patients with TP53 aberrations: a pooled analysis from four clinical trials. Br J Haematol. 2022;196:947-953.
  25. Awan FT, Schuh A, Brown JR, at al. Acalabrutinib monotherapy in patients with chronic lymphocytic leukemia who are intolerant to ibrutinib. Blood Adv. 2019;3:1553-1562.
  26. Shadman M, Flinn IW, Levy MY, et al. Phase 2 study of zanubrutinib in BTK inhibitor-intolerant patients (pts) with relapsed/refractory B-cell malignancies. 2021;138(suppl 1):1410.
  27. Wierda WG, Allan JN, Siddiqi T, et al. Ibrutinib plus venetoclax for first-line treatment of chronic lymphocytic leukemia: primary analysis results from the minimal residual disease cohort of the randomized phase II CAPTIVATE study. J Clin Oncol. 2021;39:3853-3865.
  28. Ghia P, Allan JN, Siddiqi T, et al. Fixed-duration (FD) first-line treatment (tx) with ibrutinib (I) plus venetoclax (V) for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): primary analysis of the FD cohort of the phase 2 captivate study. Presented at: 2021 American Society of Clinical Oncology Annual Meeting; June 4-8, 2021. Abstract 7501.
  29. Kater A, Owen C, Moreno C, et al. Fixed-duration ibrutinib and venetoclax (I+V) versus chlorambucil plus obinutuzumab (CLB+O) for first-line (1L) chronic lymphocytic leukemia (CLL): primary analysis of the phase 3 GLOW study. Presented at: 2021 European Hematology Association Congress; June 9-17, 2021. Abstract LB1902.
  30. Davids MS, Lampson BL, Tyekucheva S, et al. Acalabrutinib, venetoclax, and obinutuzumab as frontline treatment for chronic lymphocytic leukaemia: a single-arm, open-label, phase 2 study. Lancet Oncol. 2021;22:1391-1402.
  31. Soumerai JD, Mato AR, Dogan A, et al. Zanubrutinib, obinutuzumab, and venetoclax with minimal residual disease-driven discontinuation in previously untreated patients with chronic lymphocytic leukaemia or small lymphocytic lymphoma: a multicentre, single-arm, phase 2 trial. Lancet Haematol. 2021;8:e879-e89