Jeremy Abramson, MD, Clinical Director of the Center for Lymphoma at Massachusetts General Hospital, Boston, is not convinced that ibrutinib (Ibruvica) combined with bendamustine (Treanda) and rituximab (Rituxan) should be the new standard of care for previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). He is, however, convinced that ibrutinib monotherapy is the treatment of choice in this population.

“Ibrutinib monotherapy is well tolerated and already approved for all patients with relapsed CLL. Ibrutinib alone works remarkably well in relapsed disease, with response rates of approximately 90% and 3-year progression-free survival greater than 80% in subjects without deletions of either 17p or 11q. The study does not tell us how much bendamustine/rituximab adds to ibrutinib since ibrutinib alone works so remarkably well,” Dr. Abramson said.

Ibrutinib is a highly active regimen, and it is remarkable that a novel agent added to chemoimmunotherapy reduced the risk of disease progression or death by 80%, he continued. “But the clinician faces the decision of selecting the optimal therapy for patients previously treated with chemotherapy. My answer now is ibrutinib alone based on data to date. I’m not convinced bendamustine/rituximab is needed. That was not addressed in this trial.”

Ongoing trials are currently looking at ibrutinib alone compared with chemoimmunotherapy in patients with previously untreated CLL, and until those data are available, “I do not think ibrutinib should be the standard of care for untreated patients without a 17p deletion. Those data, however, are likely to demonstrate that ibrutinib is superior to chemoimmunotherapy as initial treatment for CLL, and with less toxicity. In the not too distant future, most patients with CLL may never require chemotherapy,” Dr. Abramson stated. ■

Disclosure: Dr. Abramson has been a consultant (scientific advisory boards) for Pharmacyclics, Gilead, Infinity, and Juno.