For CLL patients at any age, the idea of running out of treatment options is a big concern. This is especially true for those who are younger and/or raising a family. Over time, some patients may develop resistance or intolerable side effects to BTK inhibitors (Ibrutinib, Acalabrutinib, Zanubrutinib) and BCL2 inhibitors (Venetoclax) raising the question: what’s next?
Fortunately, there are current and emerging treatments that can offer hope.
Current options to treat those who have relapsed on both treatments include:
- Retreatment with a BCL2 inhibitor (alone or in combination with Obinutuzumab or a BTKi) may be an option for some patients who have previously responded to a BCL2 inhibitor.
- Clinical trials whereby participation provides access to combination treatments and to new treatments that are currently in development.
- Stem cell transplant is a possibility, though it carries the risk of graft-versus-host disease, so it’s a decision that requires careful consideration.
There are many new treatments in the pipeline. Among those we can expect to see approved for use in Canada in the next few years:
- A non-covalent BTKi, Pirtobrutinib
- A next generation BCL2, Sonrotoclax
- CAR-T (chimeric antigen receptor T-cell therapy)
In the longer-term, there are new approaches to treatment being studied such as using new classes of drugs like BTK degraders, bispecific antibodies, MALT1 inhibitors, and dual covalent/noncovalent BTK inhibitors.
These approaches are currently being tested in clinical trials to help those who have developed resistance to existing treatments, or those who have developed a Richter’s transformation.
In time these novel treatments may be approved for use by patients who need them. While these treatments are still in the experimental phase, it is reassuring to know that new treatment possibilities are in development for CLL patients.
For more information on emerging options for treatment resistant CLL, you can read the article and watch an interview with Dr. Meghan Thompson here.
For those who want more detailed information, a scientific article on this topic can be found here.
Further information related to treatment can be found in The Decision to Treat and Treatment Options section of CLL Canada’s Information and Resource Centre here.