First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era
Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion cr...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-07-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/15/3859 |
| _version_ | 1797586975109152768 |
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| author | Antonio Urso Francesco Cavazzini Maria Pia Ballardini Silvia Gambara Sara Consolo Gian Matteo Rigolin Antonio Cuneo |
| author_facet | Antonio Urso Francesco Cavazzini Maria Pia Ballardini Silvia Gambara Sara Consolo Gian Matteo Rigolin Antonio Cuneo |
| author_sort | Antonio Urso |
| collection | DOAJ |
| description | Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion criteria are heterogeneous across trials designed for older patients, and the identification of CLL-specific parameters identifying unfit patients at risk of developing drug-specific adverse events is required to guide treatment choice. Due to inclusion/exclusion criteria in trials, higher discontinuation rates with BTKi were reported in real-world studies, and registry analyses provided useful information on factors predicting earlier discontinuation in a real-world setting. Though targeted agents were shown to be cost-effective treatments in high-income countries, the out-of-pocket expenses may limit accessibility to these drugs, and the overall expenditure for new drugs in CLL is projected to increase substantially, posing an issue for sustainability. This being said, the choice of a finite-duration treatment based on venetoclax-containing regimens or treatment until progression with BTKi is today possible in high-income countries, and the therapy choice drivers are represented by coexisting medical conditions rather than age, patient expectations, logistics, and sustainability. |
| first_indexed | 2024-03-11T00:30:47Z |
| format | Article |
| id | doaj.art-d44f0c25ec094ff39607e6f460b41696 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T00:30:47Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-d44f0c25ec094ff39607e6f460b416962023-11-18T22:42:23ZengMDPI AGCancers2072-66942023-07-011515385910.3390/cancers15153859First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free EraAntonio Urso0Francesco Cavazzini1Maria Pia Ballardini2Silvia Gambara3Sara Consolo4Gian Matteo Rigolin5Antonio Cuneo6Hematology Unit, University of Ferrara, 44121 Ferrara, ItalyHematology Unit, University of Ferrara, 44121 Ferrara, ItalyHematology Unit, University of Ferrara, 44121 Ferrara, ItalyHematology Unit, University of Ferrara, 44121 Ferrara, ItalyHematology Unit, University of Ferrara, 44121 Ferrara, ItalyHematology Unit, University of Ferrara, 44121 Ferrara, ItalyHematology Unit, University of Ferrara, 44121 Ferrara, ItalyBruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion criteria are heterogeneous across trials designed for older patients, and the identification of CLL-specific parameters identifying unfit patients at risk of developing drug-specific adverse events is required to guide treatment choice. Due to inclusion/exclusion criteria in trials, higher discontinuation rates with BTKi were reported in real-world studies, and registry analyses provided useful information on factors predicting earlier discontinuation in a real-world setting. Though targeted agents were shown to be cost-effective treatments in high-income countries, the out-of-pocket expenses may limit accessibility to these drugs, and the overall expenditure for new drugs in CLL is projected to increase substantially, posing an issue for sustainability. This being said, the choice of a finite-duration treatment based on venetoclax-containing regimens or treatment until progression with BTKi is today possible in high-income countries, and the therapy choice drivers are represented by coexisting medical conditions rather than age, patient expectations, logistics, and sustainability.https://www.mdpi.com/2072-6694/15/15/3859chronic lymphocytic leukemiaolder patientBruton tyrosine kinaseBCL2cost-effectiveness |
| spellingShingle | Antonio Urso Francesco Cavazzini Maria Pia Ballardini Silvia Gambara Sara Consolo Gian Matteo Rigolin Antonio Cuneo First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era Cancers chronic lymphocytic leukemia older patient Bruton tyrosine kinase BCL2 cost-effectiveness |
| title | First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era |
| title_full | First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era |
| title_fullStr | First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era |
| title_full_unstemmed | First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era |
| title_short | First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era |
| title_sort | first line treatment of older patients with cll a new approach in the chemo free era |
| topic | chronic lymphocytic leukemia older patient Bruton tyrosine kinase BCL2 cost-effectiveness |
| url | https://www.mdpi.com/2072-6694/15/15/3859 |
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