Personalizing Therapy for CLL: Critical Considerations for Providers

As research and treatment for chronic lymphocytic leukemia (CLL) evolve, oncology providers have more methods to personalize treatment for their patients. However, providers should consider multiple factors—from genetic features to lifestyle preferences—when tailoring treatment for individuals.

Amber Koehler, MPAS, PA-C, of the Mayo Clinic, and Josie Montegaard, NP, of the Dana-Farber Cancer Institute, spoke about how providers can help personalize care for patients with CLL during JADPRO Live 2023, the Annual APSHO Meeting. Ms. Montegaard explained why having conversations with patients is so important to understand their individual needs and preferences surrounding treatment.

“We really have been able to incorporate what’s meaningful for the patient and what their lifestyle entails in order to fine tune whatever treatment may work best for them,” Ms. Montegaard said.

For example, patients living in rural areas that are distant from treatment centers can face challenges when it comes to treatments requiring frequent visits to the clinic.

“Having a [Bruton’s tyrosine kinase] inhibitor therapy as an option allows them to get great CLL treatment but not burden them in terms of the visit schedule,” Ms. Montegaard added.

Ms. Montegaard also spoke about younger adults with CLL, who “often value time off treatment because they know they have a long CLL treatment journey ahead of them.” For these patients, using a finite-duration therapy can be “really appealing to them” because it “allows them to see returning to their lives as normal as possible.”

Ms. Koehler spoke about the importance of considering disease characteristics and prognostic features in patients with CLL. It’s critical to perform testing to determine a patient’s del(17p), TP53, and IGHV status, she said, noting that it’s also important to understand if a patient has a complex karyotype. Knowing these features can help providers better tailor treatment to a given patient’s disease characteristics.

“We know that folks who get time-limited venetoclax-based regimens do have a shorter [progression-free survival] if they have some of those higher-risk features… it’s really important that we just keep that in mind with these patients,” Ms. Koehler said.

However, it’s important to recognize that the reduced progression-free survival duration with time-limited venetoclax-based regimens in patients with certain higher-risk features “doesn’t mean that it’s not necessarily a treatment regimen that you can use in those patients” if that treatment approach is “what makes the most sense for that patient,” Ms. Koehler added.

Ms. Koehler also spoke about financial considerations with indefinite therapies versus time-limited therapies, emphasizing that many people who have CLL are older adults of retirement age who are often on fixed incomes.

“There’s going to be differences in cost… I’m hopeful that there can continue to be partnerships with different patient advocacy organizations [and] pharmaceutical companies to really help patients get the medications that they need, because otherwise it can be really cost-prohibitive for many, many folks,” Ms. Koehler concluded.