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Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record.
What is in development for Chronic lymphocytic leukaemia, drawn from the whole corpus: 89 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Double-refractory disease.
Also on OnCo: Resistance atlas · Lines of therapy.
Richter transformation.
Richter transformation: median survival still under a year for clonally related cases; no approved therapy.
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Targets · KRAS roadmap.
Double-refractory disease after BTKi and venetoclax: pirtobrutinib gives ~1 year; CAR-T complete responses are only ~20%.
Also on OnCo: Resistance atlas · Lines of therapy.
Fixed duration versus continuous therapy has never been compared head to head for OS; MAJIC and CLL17 will inform.
Infections are the main threat to people living with CLL; vaccine responses are blunted and COVID-19 mortality was high, so prophylaxis and immunoglobulin replacement matter.
Second primary cancers, especially skin, on long-term therapy.
Cost: indefinite BTK inhibition costs more than $150,000 per year; access is limited in most of the world and biosimilar rituximab-based chemoimmunotherapy persists where targeted drugs are unaffordable.
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Financial help · Coverage by country · HTA decisions.
T-cell dysfunction in CLL limits CAR-T and bispecific efficacy; how to restore it (BTKi pre-treatment, allogeneic products) is open.
Optimal MRD assay, compartment (blood vs marrow), and threshold for stopping therapy are not standardised.
Background: MRD-negative complete remission. Also on OnCo: Treatment journeys · Survivorship planner.
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
On EdgeAll 82 changes by month →When this page itself was last checked or edited.
Fixed-duration acalabrutinib + venetoclax, previously untreated CLL/SLL without del(17p)/TP53 (AMPLIFY)
Pirtobrutinib if BTK-naive-to-noncovalent; lisocabtagene maraleucel CAR-T (TRANSCEND CLL 004; accelerated approval 2024); allogeneic transplant in fit patients; PI3K inhibitors (idelalisib, duvelisib) rarely; clinical trials of degraders, sonrotoclax, bispecifics. (NCCN Category 2A)
Watch and wait with periodic counts and examination; early treatment with ibrutinib (CLL12) delayed progression but did not improve survival and is not recommended. Vaccinations and infection prevention. (NCCN Category 1 (observation))
FCR only for young, fit, IGHV-mutated, TP53-intact patients who decline targeted therapy or lack access; BR in older patients likewise. Outperformed by targeted therapy in CLL13, ELEVATE-TN, SEQUOIA, AMPLIFY. (NCCN Category 2A (select patients))
Acalabrutinib (± obinutuzumab, ELEVATE-TN) or zanubrutinib (SEQUOIA) until progression; ibrutinib where alternatives are unavailable. Preferred for del(17p)/TP53 and for patients who cannot manage venetoclax ramp-up or TLS monitoring. (NCCN Category 1 (acalabrutinib, zanubrutinib preferred))