Debate - What is Optimal First-Line Therapy for Chronic Lymphocytic Leukemia: Chemoimmunotherapy or Small Molecule Inhibitor Therapy?

The treatment landscape of first-line therapy for chronic lymphocytic leukemia (CLL) has evolved significantly in recent years. The selection of optimal first line treatment should be based on several factors related to patient (age, performance status and comorbid conditions), disease (clinical stage, cytogenetic or molecular characteristics [del(17p) or TP53 mutation, complex karyotype and IGHV mutation status]) and treatment (agent’s toxicity profile). Careful monitoring of adverse events after initiation of treatment and supportive care for the treatment related complications (e.g., use of non-warfarin anticoagulant therapies in patients receiving ibrutinib; gradual step wise ramp up to target dose along with prophylaxis for TLS to mitigate the risk and frequency of TLS associated with venetoclax) should be an integral part of CLL management to achieve the full clinical benefit. Educating the clinicians about the recent clinical advances and the benefits/risks associated with the use of chemoimmunotherapy vs. targeted therapy can help them to make informed clinical decisions and develop an individualized treatment plan.

Target Audience

This educational program is designed to meet the educational needs of physicians/oncologists, nurse practitioners, nurses, physician assistants, pharmacists, and other health care professionals who manage patients with cancer.

Learning Objectives

Following this program, participants should be able to:

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

This activity is supported by educational grants from:

  • AstraZeneca
  • BeiGene, Ltd.
  • Celgene Corporation
  • Daiichi Sankyo, Inc.
  • Eisai
  • Genentech, a member of the Roche Group
  • Ipsen Biopharmaceuticals, Inc.
  • Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC
  • Jazz Pharmaceuticals, Inc.
  • Lilly
  • Novartis
  • NOVOCURE
  • Pfizer Inc.
  • Puma Biotechnology
  • Sanofi Genzyme
  • Taiho Oncology, Inc.
  • TESARO, a GSK Company

 This activity is supported by independent medical education grants from:

  • Bristol-Myers Squibb
  • Illumina, Inc.

This activity is supported by independent educational grants from:

  • AbbVie
  • Astellas
  • Boehringer Ingelheim Pharmaceuticals, Inc.
  • Incyte
  • Merck & Co., Inc.

This activity is supported by a medical education grant from Exelixis, Inc.

This activity is supported by an unrestricted educational grant from Kite, a Gilead Company

This project has been made possible in part by a grant from the Varian Medical Systems Educational Grant Corporate Fund, an advised fund of Silicon Valley Community Foundation

Course summary
Available credit: 
  • 1.25 AAPA Category 1 CME credit
  • 1.25 ACPE contact hours
  • 1.25 AMA PRA Category 1 Credit™
  • 1.25 ANCC contact hours
  • 1.25 Participation
Course opens: 
05/18/2020
Course expires: 
03/01/2021
Cost:
$0.00
Part of: 
NCCN 2020 Virtual Annual Conference

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

Presenters: 
Mazyar Shadman, MD, MPH    
Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance    

Deborah Stephens, DO    
Huntsman Cancer Institute at the University of Utah    

Panelists: 
Julio C. Chavez, MD    
Moffitt Cancer Center    

Shuo Ma, MD, PhD    
Robert H. Lurie Comprehensive Cancer Center of Northwestern University
 

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:

Julio C. Chavez, MD
AstraZeneca Pharmaceuticals LP: Product/Speakers Bureau 
Bayer HealthCare: Consulting Fee
BeiGene: Product/Speakers Bureau
Genentech, Inc: Product/Speakers Bureau
Karyopharm Therapeutics: Consulting Fee
Kite Pharma: Consulting Fee
Merck & Co., Inc.: Grant/Research Support
MorphoSys AG: Consulting Fee
Novartis Pharmaceuticals Corporation: Consulting Fee

Shuo Ma, MD, PhD
AbbVie, Inc.: Grant/Research Support
AstraZeneca Pharmaceuticals LP: Grant/Research Support; Product/Speakers Bureau
BeiGene: Grant/Research Support; Product/Speakers Bureau
Genentech, Inc.: Scientific Advisor
Janssen Pharmaceutica Products, LP: Grant/Research Support; Product/Speakers Bureau
Juno Therapeutics, Inc.: Grant/Research Support
Kite Pharma: Scientific Advisor
Pharmacyclics: Grant/Research Support; Product/Speakers Bureau
TG Therapeutics: Grant/Research Support

Mazyar Shadman, MD, MPH
AbbVie, Inc.: Scientific Advisor; Grant/Research Support
Acerta Pharma: Grant/Research Support
ADC Therapeutics: Scientific Advisor
AstraZeneca Pharmaceuticals LP: Scientific Advisor; Grant/Research Support
Atara Biotherapeutics: Scientific Advisor
BeiGene: Grant/Research Support
Celgene Corporation: Grant/Research Support
Cellectar Biosciences: Scientific Advisor
Genentech, Inc.: Grant/Research Support
Gilead Sciences, Inc.: Grant/Research Support
Merck & Co., Inc.: Grant/Research Support
Mustang Bio: Grant/Research Support
Pharmacyclics: Scientific Advisor; Grant/Research Support
Sound Biologics: Scientific Advisor
Sunesis Pharmaceuticals, Inc.: Grant/Research Support
TG Therapeutics: Grant/Research Support
Verastem: Scientific Advisor

Deborah Stephens, DO 
Acerta Pharma: Grant/Research Support
Gilead Sciences, Inc.: Grant/Research Support
Janssen Pharmaceutica Products, LP: Consulting Fee
Juno Therapeutics, Inc.: Grant/Research Support
Karyopharm Therapeutics: Grant/Research Support
Pharmacyclics: Consulting Fee

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

NCCN Staff Disclosures 

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

The NCCN Activity Planning staff listed below discloses the following relevant financial relationships:
Wui-Jin Koh, MD
IBM Watson Health for Oncology and Genomics; Scientific Advisor

The NCCN Clinical staff listed below discloses no relevant financial relationships:
Mary A. Dwyer, MS, CGC; Rashmi Kumar, PhD; 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 material for a maximum of 1.25 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 1.25 contact hours.

Pharmacists
NCCN designates this knowledge-based continuing education activity for 1.25 contact hours (0.125 CEUs) of continuing education credit. UAN: JA4008196-0000-20-058-H01-P

Physician Assistants
NCCN has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.25 AAPA Category 1 CME credits.  Approval is valid until March 1, 2021. PAs should only claim credit commensurate with the extent of their participation.

Available Credit

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

Price

Cost:
$0.00
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Required Hardware/software

To complete this activity, users will need: