title: Novel Therapies for Chronic Lymphocytic Leukemia: A Canadian Perspective.
abstract: Chronic lymphocytic leukemia (CLL) is the most common adult lymphoproliferative disorder in Western countries. The current standard of care for CLL is chemoimmunotherapy, typically with fludarabine, cyclophosphamide, and rituximab (FCR). However, most patients with CLL are elderly with comorbidities and are unable to tolerate FCR. In order to choose the best treatment for each individual patient, physicians must balance efficacy with toxicity. In addition, most currently available treatments are ineffective in CLL patients with loss of TP53. Two groups of novel therapeutic agents-anti-CD20 monoclonal antibodies and small molecule inhibitors-are attempting to address these issues, and 5 of these agents have progressed to phase 3 trials: obinutuzumab, idelalisib, ibrutinib, venetoclax (ABT-199), and duvelisib (IPI-145). We present the current evidence for these novel agents in the treatment of CLL, along with the perspectives of 4 Canadian oncology experts.
authors.affiliation: Division of Hematology and Hematological Malignancies, Foothills Medical Centre, Calgary, Alberta, Canada. Electronic address: Carolyn.Owen@albertahealthservices.ca.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Owen
authors.affiliation: Division of Hematology, McGill University, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Sarit
authors.initials: S
authors.lastname: Assouline
authors.affiliation: Department of Medical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Kuruvilla
authors.affiliation: New Evidence, Toronto, Ontario, Canada.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Uchida
authors.affiliation: New Evidence, Toronto, Ontario, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bellingham
authors.affiliation: BC Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Laurie
authors.initials: L
authors.lastname: Sehn
mesh_terms: D005104:Expert Testimony; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D058990:Molecular Targeted Therapy; D016896:Treatment Outcome
keywords: Chronic lymphocytic leukemia; Duvelisib; Ibrutinib; Idelalisib; Monoclonal antibodies; Obinutuzumab; Small molecule inhibitors; Venetoclax