Anthony Mato, MD, MSCE, a hematologic oncologist and director of the CLL Program at Memorial Sloan Kettering Cancer Center, discusses an observational registry study of real-world prognostic biomarker testing, treatment patterns, and treatment dosing in a pool of 1461 patients with either chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia.

The uniqueness of performing a registry study is that it provides the opportunity to see if oncology practices are following the recommendations of governing bodies like the National Comprehensive Cancer Network, and the International Workshop on CLL, says Mato. Also, with a large collection of new data being released at medical conferences each year, prospectively evaluating the field can show how the latest treatment strategies are being implemented.

Results from the study were eye-opening, Mato explains. It was shown that a small proportion of patients treated in the real-world had the recommended prognostic biomarker testing. Because of this lack of testing, oncologists made treatment decisions that would not be considered the standard in today’s treatment landscape. Instead of administering ibrutinib (Imbruvica) or another targeted therapy to patients with del(17p) or TP53-mutated disease, the data showed that oncologists gave chemoimmunotherapy, Mato notes.

While there are risks involved with CAR T-cell therapy, it could become a more popular therapy choice for younger patients with chronic lymphocytic leukemia (CLL) compared to bone marrow transplant, which can be even more difficult to tolerate, says Dr. Matthew Davids of the Dana-Farber Cancer Institute.

In an interview with CURE®, Davids explained that younger patients with CLL, particularly those with more high-risk disease who have relapsed despite a number of previous treatments, could find CAR T-cell therapy treatment a more tolerable option than the standard of allogeneic transplantation.

By harnessing and reprogramming the body’s own cells to fight cancer, CAR T-cell therapy has had success in a number of other cancer types in the past decade or so, Davids noted. And while it’s not currently approved for use in CLL, it is being examined in various combinations that could prove successful down the road.

Transcription:

One other thing that comes to mind as we think about where the field is headed in the future is that we’ve seen some early but promising data for CAR T-cell based therapies. This is using the patient’s own T lymphocyte cells, educating them outside the body and then reinfusing them to try to have a sustained response to CLL.

And although this is not yet an FDA approved treatment in CLL, I think it’s showing promise. I think about it for my younger patients, particularly those who have maybe been through a few lines of CLL treatment already, particularly if they have very high-risk disease like the TP53 deletion or mutation. You know, currently, those are patients we think about bone marrow transplant, allogeneic transplantation for, but that certainly has some very serious risks. And even though CAR T-cell therapy also has risks, I think, in general, the toxicity profile is more favorable than allogeneic transplantation.

We’ve started to see some patients with very long-term remissions now from CAR T. So I’m excited to see the how that field evolves in the coming years. There are people exploring various combinations of different drugs with CAR T. And so, I think the technology and the combination therapies will improve over time. And so I do think that for younger patients who have a long time horizon, that could eventually be an approved option to think about down the road.

Because patients with chronic lymphocytic leukemia (CLL) can sometimes be more susceptible to infections and other types of cancers, Dr. Matthew Davids of the Dana-Farber Cancer Institute has some tips that will help patients stay healthy, whether they are on active treatment or taking a watch-and-wait approach to treatment.

In an interview with CURE®, Davids noted that keeping up on vaccinations and maintaining a regular cancer screening schedule are two ways that patients can take an active role in their health, regardless of their treatment plans.

Editor’s note: This interview was conducted prior to the two emergency use authorizations of the Pfizer-BioNTech and Moderna COVID-19 vaccines.

Transcription:

So, one thing that’s very important is that CLL patient’s kind of stay up to date on other sort of health care maintenance things that they should be doing. An obvious one is vaccinations. We know that patients who have CLL are more susceptible to infections, so basic things like getting a flu shot every year, getting pneumonia shots every five years, even if you’re under age 65, getting the Shingrix vaccination to help prevent shingles. And eventually, once we hopefully have a COVID vaccine, getting COVID vaccination. So being mindful of infection risk is important.

The second thing is that CLL patients, by virtue of having the disease, are at a higher risk of developing other forms of cancer. I don’t recommend that CLL patients necessarily need additional screening beyond what’s recommended for the general population, but they should at least make sure that they’re staying up to date on what they’re supposed to be doing. Things like colonoscopy, at whatever interval is appropriate for them.

Mammography and gynecological exams for women, these sorts of things are very important to try to catch these early cancers. And one that sometimes gets overlooked is dermatologic surveillance. So, I make sure that all my CLL patients are seeing a dermatologist at least once a year to keep a close eye on their skin for early skin cancers.

Those are all things that should be going on even in CLL patients who are not on active treatment, even if they’re on our watch and wait or observation strategy, they need to be mindful of those risks

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