Expert Point of View: Robert Brodsky, MD and Henry Fung, MD, FACP, FRCPE

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“Several new drugs that have been approved for the treatment of chronic lymphocytic leukemia (CLL) are changing the landscape of this disease. CLL is associated with a long survival, so we will need longer follow-up to see how deep the responses are,” said Robert Brodsky, MD, Director of Hematology and Professor at Johns Hopkins Medicine in Baltimore. “We will need to identify rational safe therapeutic combinations with all the new agents available for this disease,” he continued.

In the CLARITY phase II trial reported at the 2017 American Society of Hematology Annual Meeting & Exposition, the combination of venetoclax (Venclexta) and ibrutinib (Imbruvica) showed encouraging results in relapsed/refractory CLL, he noted.1 This combination will be studied in a phase III trial. Other combinations of newer drugs are also under study.

Dr. Brodsky added, “The phase III MURANO study suggests that venetoclax/rituximab (Rituxan) will be practice-changing. We are getting away from chemotherapy and avoiding alkylating agents.”

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Henry Fung, MD, FACP, FRCPE, Vice Chair, Department of Hematology/Oncology, Director, Fox Chase–Temple University Hospital Bone Marrow Transplant Program, Fox Chase Cancer Center, Philadelphia, also commented on the study: “In the MURANO trial, venetoclax plus rituximab compared favorably to bendamustine plus rituximab in patients with relapsed/refractory CLL. Not only is there an 83% reduction in the risk of a progression-free survival event, overall survival also improved by 52%, despite a short median follow-up of 2 years. The depth of the responses was unprecedented, with a complete response/incomplete platelet recovery rate of 26.8% and peripheral blood minimum residual disease–negative rate of 83.5%,” he noted.

“Longer follow-up will be required to determine the durability of the responses. It will be important to compare venetoclax/rituximab with existing and investigational kinase inhibitors. Based on the reported progression-free survival, overall response rates, and tolerability, use of venetoclax/rituximab will likely extend beyond poor-prognosis del(17p) CLL, and certainly this will become one of the preferred treatments for patients with relapsed/refractory CLL,” Dr. Fung predicted. ■

DISCLOSURE: Drs. Brodsky and Fung reported no conflicts of interest.


1. Hillmen P, Munir T, Rawstron A, et al: Initial results of ibrutinib plus venetoclax in relapsed refractory CLL (Bloodwise TAP CLARITY Study): High rates of overall response, complete remission, and MRD eradication after 6 months of therapy. 2017 ASH Annual Meeting. Abstract 428. Presented December 10, 2017.

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