Venetoclax vs. BTK Inhibitors in CLL Treatment

Choosing Venetoclax vs. BTK Inhibitors in Frontline Setting for CLL Patients

• The treatment for CLL has expanded with the approval of venetoclax (brand name: Venclexta) plus obinutuzumab (brand Name: Gazyva) in the frontline setting
• Some patients are willing to put up with the multiple infusions and possible side effects
• Those who would rather not go into the hospital as often for infusions can start on a BTK inhibitor

In 2019, the FDA approved the combination regimen venetoclax (brand name: Venclexta) plus obinutuzumab (brand Name: Gazyva) as a frontline treatment for chronic lymphocytic leukemia (CLL). Though this combination significantly improves progression-free survival compared with obinutuzumab plus the chemotherapy drug chlorambucil, and it’s a time-limited regimen, the multiple infusions and potential side effects warrant careful consideration.

“When I’m meeting a patient with CLL who needs frontline therapy … I am having a discussion with them about whether or not a year of therapy with venetoclax and obinutuzumab is right for them,” Dr. James Gerson, hematologist-oncologist at Penn Medicine, tells SurvivorNet Connect. “I don’t want to push patients into any decision-making, so I present them with options.”

Some of his patients are willing to put up with the hassle of multiple infusions, blood draws, and the potential risk of tumor lysis syndrome in exchange for a shorter duration of treatment. Others say it’s too much work, especially during COVID-19. “They don’t want to come in and out of the hospital that often. They’d rather be at home, sheltering in place and not leaving,” he says. For those patients who aren’t willing to undergo those hassles for the first two months, Dr. Gerson may start them on a BTK inhibitor.

Dr. Gerson checks in with his patients on BTK inhibitors about a month after they begin, to see if they’re having any side effects. “If they’re doing well, I see them every few months and patients really don’t need to be closely monitored. The flip side is that once you start a BTK inhibitor, you’re on it for the long run.”