How I Treat: First-Line Therapy for Chronic Lymphocytic Leukemia in the Era of BTK Inhibition

Dr. Mazyar Shadman introduces the program on first-line CLL therapy in the era of BTK inhibition, joined by Dr. Andrew Lipsky.

Dr. Shadman explains that high-risk definitions evolve as treatments change.

Dr. Lipsky outlines MRD testing utility across the three major treatment approaches.

Dr. Lipsky addresses the framework for interpreting real-world data and cross-trial comparisons in the absence of head-to-head trials.

Andrew Lipsky, MD, reviews the ELEVATE-TN trial supporting acalabrutinib approval in frontline CLL, demonstrating superiority over chlorambucil-obinutuzumab.

Dr. Shadman notes that discussions about elderly patients with CLL increasingly focus on patients aged 80 years and older, given the disease's median diagnosis age of 68 to 70 years.

Dr. Shadman introduces an important practical consideration from Flatiron real-world data examining BTKi discontinuation rates in elderly patients, challenging the notion that older patients with CLL need only one line of therapy.

Dr. Shadman introduces pirtobrutinib, the non-covalent BTKi currently approved as second-line therapy after covalent BTKi exposure.

Dr. Shadman addresses when to switch within the BTKi class versus changing mechanism of action.

Dr. Shadman presents a case of a 68-year-old woman with symptomatic CLL requiring treatment.

Dr. Lipsky presents a second case of a 72-year-old man with symptomatic CLL requiring therapy.