Debate – Evolving Strategies in First-Line Chronic Lymphocytic Leukemia: Is There a Role for Chemoimmunotherapy?

The treatment landscape of first-line therapy for chronic lymphocytic leukemia (CLL) has evolved significantly in recent years. Chemoimmunotherapy with anti-CD20 monoclonal antibodies (rituximab, obinutuzumab or ofatumumab) has significantly improved survival outcomes and targeted therapy with small molecule inhibitors has emerged as an effective therapeutic strategy. The choice of first‑line treatment for CLL should be based on the disease stage, patient’s age, performance status and comorbid conditions, presence or absence of del(17p)/TP53 mutation, IGHV mutation status and the agent’s toxicity profile. Careful monitoring of adverse events after initiation of treatment and supportive care for the treatment‑related complications should be an integral part of CLL management to achieve the full clinical benefit. Clinicians are challenged to remain up-to-date on therapeutic advances and the clinical considerations impacting treatment of CLL.  Educating clinicians about the recent clinical advances in first-line therapy for CLL and the benefits/risks associated with the use of chemoimmunotherapy and targeted therapy can help them to make informed clinical decisions for individual patients.

This information was originally presented at the NCCN 2019 Annual Congress: Hematologic Malignancies™  held in San Francisco, CA, on September 27-28, 2019.

Target Audience

This educational program is designed to meet the educational needs of the interprofessional oncology care team, including: physicians/oncologists, nurses, physician assistants, pharmacists, and other healthcare professionals who manage patients with cancer.

Learning Objectives

Following this program, participants should be able to:

  • Summarize the evidence from recent clinical trials supporting the use of targeted therapy for patients with newly diagnosed chronic lymphocytic leukemia. 
  • Recognize the emerging role of IGHV mutation status in the selection of first-line therapy, and identify patients with newly diagnosed chronic lymphocytic leukemia who could be candidates for chemoimmunotherapy.
  • Develop an individualized treatment plan for patients with newly diagnosed chronic lymphocytic leukemia based on the disease-specific and patient-specific characteristics.
Additional information
Supporters: 

This activity is supported by educational grants from:

  • Agios Pharmaceuticals
  • AstraZeneca
  • BeiGene, Ltd.
  • Celgene Corporation
  • Coherus Biosciences
  • Genentech
  • Jazz Pharmaceuticals, Inc.
  • Pfizer Inc.
  • Pharmacyclics LLC, an AbbVie Company and Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC
  • Seattle Genetics, Inc.
  • Servier Pharmaceuticals, LLC
  • Takeda Oncology

This activity is supported by educational funding provided by Amgen.

This activity is supported by an independent educational grant from AbbVie.

This activity is supported by an unrestricted educational grant from Gilead Sciences, Medical Affairs.

Course summary
Available credit: 
  • 0.75 AAPA Category 1 CME credit
  • 0.75 ACPE contact hours
  • 0.75 AMA PRA Category 1 Credit™
  • 0.75 ANCC contact hours
  • 0.75 Participation
Course opens: 
11/01/2019
Course expires: 
10/31/2020
Cost:
$0.00
Part of: 
Recorded Presentations from the NCCN 2019 Annual Congress: Hematologic Malignancies™

Facilitated by:     
Andrew D. Zelenetz, MD, PhD
Memorial Sloan Kettering Cancer Center

Presented by:    
Jennifer R. Brown, MD, PhD
Dana-Farber Cancer Institute

William G. Wierda, MD, PhD
The University of Texas MD Anderson Cancer Center

Panelists:     
Jeremy S. Abramson, MD, MMSc
Massachusetts General Hospital Cancer Center

Nitin Jain, MD
The University of Texas MD Anderson Cancer Center

Jae Park, MD
Memorial Sloan Kettering Cancer Center

NCCN Medical Education Disclosure Policy
It is the policy of NCCN that every 12 months, all faculty, moderators, activity planners and all internal planning staff participating in NCCN continuing education activities are expected to disclose any financial relationships with a commercial interest as defined by the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support. In addition, all faculty presentations have been reviewed for adherence to the ACCME’s Standards for Commercial Support (the provider develops activities/educational interventions independent of commercial interests [SCS 1, 2 and 6] by experts on the topics). 

Per the ACCME Standards for Commercial Support, individuals who do not disclose relevant financial relationships will be disqualified from involvement in the CE activity as a content developer, planner, or presenter. A complete list of individuals’ relationships with external entities is available upon request.

Definitions  
NCCN continuing education considers financial relationships to create a “conflict of interest” when an individual has both a financial relationship with a commercial interest and the opportunity to affect CE content about the products or services of a commercial interest with which he/she and/or a spouse or partner has a financial relationship.

NCCN continuing education considers “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. NCCN does not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. 

Faculty Disclaimers  
All faculty for this continuing education activity are competent in the subject matter and qualified by experience, training, and/or preparation for the tasks and methods of delivery.

Faculty presentations may include discussion of off-label use. Faculty will disclose that the use in question is not currently approved by the FDA per the product labeling.

Faculty Disclosures 
The faculty listed below discloses the following relevant financial relationships:

Andrew D. Zelenetz, MD, PhD
AbbVie, Inc.: Consulting Fee; Scientific Advisor
Adaptive Biotechnologies Corporation: Consulting Fee
Amgen Inc.: Consulting Fee
AstraZeneca Pharmaceuticals LP: Consulting Fee; Scientific Advisor
BeiGene: Grant/Research Support; Other Financial Benefit
Celgene Corporation: Consulting Fee
Genentech, Inc./Roche Laboratories, Inc.: Consulting Fee
Gilead Sciences, Inc.: Consulting Fee; Grant/Research Support 
Janssen Pharmaceutica Products, LP: Consulting Fee 
MEI Pharma Inc.: Grant/Research Support
MorphoSys AG: Scientific Advisor
Novartis Pharmaceuticals Corporation: Consulting Fee 
Pharmacyclics: Consulting Fee
Roche Laboratories, Inc.: Grant/Research Support

Jennifer R. Brown, MD, PhD
AbbVie, Inc.: Consulting Fee
Acerta Pharma: Consulting Fee
AstraZeneca Pharmaceuticals LP: Consulting Fee
BeiGene: Consulting Fee
Catapult Therapeutics: Consulting Fee
Dynamo Therapeutics: Consulting Fee
Gilead Sciences, Inc.: Grant/Research Support
Janssen Pharmaceutica Products, LP: Honoraria
Juno Therapeutics, Inc./Celgene Corporation: Consulting Fee
Kite Pharma: Consulting Fee
Loxo Oncology, Inc.: Grant/Research Support
MorphoSys AG: Other financial benefit
Novartis Pharmaceuticals Corporation: Consulting Fee
Octapharma: Consulting Fee 
Pharmacyclics: Consulting Fee 
Sun Pharmaceutical Industries Ltd.: Honoraria 
Sunesis Pharmaceuticals, Inc.: Consulting Fee 
Teva Pharmaceutical Industries Ltd: Honoraria 
TG Therapeutics: Consulting Fee
Verastem, Inc.: Consulting Fee; Grant/Research Support 

William G. Wierda, MD, PhD
AbbVie, Inc. Grant/Research Support
Acerta Pharma: Grant/Research Support
Cyclacel Pharmaceuticals, Inc.: Grant/Research Support
Genentech, Inc. Grant/Research Support
Gilead Sciences, Inc.: Grant/Research Support
GlaxoSmithKline/Novartis Pharmaceuticals Corporation: Grant/Research Support
Janssen Pharmaceutica Products, LP: Grant/Research Support
Juno Therapeutics, Inc.: Grant/Research Support
Kite Pharma: Grant/Research Support
Loxo Oncology, Inc.: Grant/Research Support
miRagen Therapeutics, Inc.: Grant/Research Support
Oncternal Therapeutics, Inc.: Grant/Research Support
Pharmacyclics: Grant/Research Support
Sunesis Pharmaceuticals, Inc.: Grant/Research Support
Xencor, Inc.: Grant/Research Support 

Jeremy S. Abramson, MD, MMSc
AbbVie, Inc.: Consulting Fee
Bayer HealthCare: Consulting Fee
Celgene Corporation: Consulting Fee
EMD Serono: Consulting Fee
Genentech, Inc.: Consulting Fee
Janssen Pharmaceutica Products, LP: Consulting Fee
Karyopaharm Therapeutics: Consulting Fee 
Kite Pharma: Consulting Fee
Roche Laboratories, Inc.: Consulting Fee 

Nitin Jain, MD
AbbVie, Inc.: Consulting Fee; Grant/Research Support; Honoraria; Scientific Advisor
Adaptive Biotechnologies: Consulting Fee; Grant/Research Support; Honoraria; Scientific Advisor
ADC Therapeutics: Grant/Research Support
AstraZeneca Pharmaceuticals LP: Consulting Fee; Grant/Research Support; Honoraria; Scientific Advisor
Bristol-Myers Squibb Company: Grant/Research Support
Cellectis: Grant/Research Support
Genentech, Inc.: Consulting Fee; Grant/Research Support; Honoraria; Scientific Advisor
Incyte Corporation: Grant/Research Support
Janssen Pharmaceutica Products, LP: Consulting Fee; Honoraria; Scientific Advisor
Pfizer Inc.: Grant/Research Support
Pharmacyclics: Consulting Fee; Grant/Research Support; Honoraria; Scientific Advisor
Precision Biosciences: Consulting Fee; Grant/Research Support; Honoraria; Scientific Advisor
Servier: Grant/Research Support
Verastem, Inc.: Consulting Fee; Grant/Research Support; Honoraria; Scientific Advisor 

Jae Park, MD
Allogene Therapeutics: Consulting Fee
Amgen Inc.: Consulting Fee
AstraZeneca Pharmaceuticals LP: Consulting Fee
Incyte Corporation: Consulting Fee
Kite Pharma: Consulting Fee
Novartis Pharmaceuticals Corporation: Consulting Fee
Takeda Pharmaceuticals North America, Inc.: Consulting Fee 
 

NCCN Staff Disclosures 

The NCCN Activity Planning staff listed below discloses no relevant financial relationships: 
Melissa Esplen; Mark A. Geisler; Kristina M. Gregory, RN, MSN, OCN; Kristin Kline Hasson; Rose Joyce; Karen Kanefield; Lisa Perfidio, MS; Shannon Ryan, CMP; Sarah Sinclair; Kathy Ann Smith, CHCP 

The NCCN Leadership listed below discloses no relevant financial relationships: 
Robert W. Carlson, MD; Wui-Jin Koh, MD; Gary J. Weyhmuller, MBA, SPHR  

The NCCN Clinical staff listed below discloses no relevant financial relationships: 
Mary A. Dwyer, MS, CGC; Hema Sundar, PhD 

In support of improving patient care, National Comprehensive Cancer Network (NCCN) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

Physicians 
NCCN designates this enduring activity for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Nurses 
NCCN designates this educational activity for a maximum of .75 contact hours. 

Pharmacists
NCCN designates this knowledge-based continuing education activity for .75 contact hours (0.075 CEUs) of continuing education credit. UAN: JA4008196-0000-19-088-H01-P

Physician Assistants 
NCCN has been authorized by the American Academy of PAs (AAPA) to award AAPA Catergory 1 CME credit for activities planned in accordance with AAPA CME criteria. This activity is designated for .75 AAPA Catergory 1 CME credits. Approval is valid until October 31, 2020. PAs should only claim credit commensurate with the extent of their participation. 

Available Credit

  • 0.75 AAPA Category 1 CME credit
  • 0.75 ACPE contact hours
  • 0.75 AMA PRA Category 1 Credit™
  • 0.75 ANCC contact hours
  • 0.75 Participation

Price

Cost:
$0.00
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Required Hardware/software

To complete this activity, users will need: