Abstract

Purpose of Review

The therapeutic landscape for chronic lymphocytic leukemia (CLL) has undergone a complete makeover following the introduction of highly effective targeted therapies, beginning with ibrutinib which first attained regulatory approval for CLL in 2014.

Recent Findings

In recent years, we have seen further refinement of therapeutic options with the development of newer-generation Bruton’s tyrosine kinase inhibitors (BTKi) including acalabrutinib and zanubrutinib that improve upon the safety of ibrutinib. Additionally, venetoclax-based approaches, combined with anti-CD20 antibodies, have allowed for time-limited targeted therapeutic strategies which are particularly attractive for certain subsets of patients though have demonstrated efficacy across all subgroups. Lastly, there is an ongoing movement toward the development of time-limited strategies inclusive of both a BTKi and venetoclax that may further widen potential options.

Summary

CLL patients requiring frontline therapy have a unique burden of choice between highly effective therapies that differ substantially with respect to side effect profiles and schedules. This review will focus on the frontline management of CLL in the setting of these rapidly changing options.

中文翻译：

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CLL 的一线治疗——改变治疗模式

摘要

审查目的

随着高效靶向疗法的推出，慢性淋巴细胞白血病 (CLL) 的治疗格局经历了彻底的转变，首先是伊布替尼 (ibrutinib)，该药物于 2014 年首次获得监管部门批准用于治疗 CLL。

最近的发现

近年来，随着包括 acalabrutinib 和 zanubrutinib 在内的新一代布鲁顿酪氨酸激酶抑制剂 (BTKi) 的开发，治疗方案进一步完善，提高了 ibrutinib 的安全性。此外，基于 Venetoclax 的方法与抗 CD20 抗体相结合，可以实现限时靶向治疗策略，尽管已在所有亚组中证明了疗效，但该策略对某些患者亚群特别有吸引力。最后，目前正在制定限时策略，包括 BTKi 和 Venetoclax，这可能会进一步拓宽潜在的选择。

概括

需要一线治疗的 CLL 患者在高效疗法之间面临着独特的选择负担，这些疗法在副作用概况和时间表方面存在很大差异。本次审查将重点关注在这些快速变化的选择背景下 CLL 的一线管理。