Awan Farrukh T, Al-Sawaf Othman, Fischer Kirsten, Woyach Jennifer A
Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, Germany.
Am Soc Clin Oncol Educ Book. 2020 Mar;40:1-10. doi: 10.1200/EDBK_279099.
Therapy for chronic lymphocytic leukemia has improved dramatically over the past decade with the introduction of new targeted therapies and a paradigm shift toward targeted therapies for the majority of patients. Better understanding of prognostic factors has helped tailor therapy for individual patients, and work continues to identify optimal therapy for each patient. When therapy is required, most patients will be treated with targeted therapies, either the Bruton tyrosine kinase (BTK) inhibitors ibrutinib or acalabrutinib or the BCL-2 inhibitor venetoclax in combination with obinutuzumab. Without head-to-head comparisons showing differential efficacy among these options, considerations regarding safety, patient preference, and ability to sequence therapy currently influence treatment decisions. Also, clinical trials investigating combinations of these therapies have the potential to further change the standard of care. In this review, we cover the currently available options for the frontline treatment of chronic lymphocytic leukemia (CLL) and discuss safety considerations and toxicity management with each agent as well as novel combination strategies currently under investigation.
在过去十年中，随着新的靶向治疗方法的引入以及针对大多数患者的治疗模式向靶向治疗的转变，慢性淋巴细胞白血病的治疗取得了显著进展。对预后因素的更好理解有助于为个体患者量身定制治疗方案，并且仍在继续努力为每位患者确定最佳治疗方法。当需要进行治疗时，大多数患者将接受靶向治疗，即布鲁顿酪氨酸激酶（BTK）抑制剂伊布替尼或阿卡替尼，或BCL-2抑制剂维奈克拉与奥妥珠单抗联合使用。由于缺乏这些选择之间疗效差异的头对头比较，目前关于安全性、患者偏好以及治疗顺序安排能力的考虑因素会影响治疗决策。此外，研究这些治疗方法组合的临床试验有可能进一步改变治疗标准。在本综述中，我们涵盖了慢性淋巴细胞白血病（CLL）一线治疗目前可用的选择，并讨论了每种药物的安全性考虑因素和毒性管理，以及目前正在研究的新型联合策略。
