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Frontline Treatment of the Young, Fit Patient with CLL: A Canadian Perspective

From a Canadian perspective, there has been a limited discussion on the frontline management of young, fit patients with chronic lymphocytic leukemia (CLL). The prevalence of this population ranges between 2 and 22 per 100,000 persons in Canada and varies by region. Until recently, fixed-duration fl...

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Autores principales: Costello, Jacqueline, Kang, Matthew, Banerji, Versha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534822/
https://www.ncbi.nlm.nih.gov/pubmed/34677244
http://dx.doi.org/10.3390/curroncol28050326
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author Costello, Jacqueline
Kang, Matthew
Banerji, Versha
author_facet Costello, Jacqueline
Kang, Matthew
Banerji, Versha
author_sort Costello, Jacqueline
collection PubMed
description From a Canadian perspective, there has been a limited discussion on the frontline management of young, fit patients with chronic lymphocytic leukemia (CLL). The prevalence of this population ranges between 2 and 22 per 100,000 persons in Canada and varies by region. Until recently, fixed-duration fludarabine-based chemoimmunotherapy (CIT) was the primary treatment option in Canada for this patient population. The ECOG1912 trial has since demonstrated that ibrutinib and rituximab therapy are as effective as fludarabine-cyclophosphamide-rituximab (FCR) in this population. The ALLIANCE trial showed that rituximab added no incremental benefit to ibrutinib. Canadian payors and physicians adopted ibrutinib monotherapy as the CLL standard of care, even in the young, fit population, although frontline ibrutinib therapy is often reimbursed by provincial public drug plans only in patients with high-risk disease or those who are unfit to receive fludarabine. Young, fit patients with CLL and their physicians may now choose between continuous ibrutinib monotherapy and fixed-duration CIT with FCR. Factors affecting this choice include patient preference and the short- and long-term toxicity profiles of both regimens, and a risk-based algorithm is provided. As new continuous-therapy options enter the market, all treatment choices present benefits and risks that must be communicated to the patient.
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spelling pubmed-85348222021-10-23 Frontline Treatment of the Young, Fit Patient with CLL: A Canadian Perspective Costello, Jacqueline Kang, Matthew Banerji, Versha Curr Oncol Review From a Canadian perspective, there has been a limited discussion on the frontline management of young, fit patients with chronic lymphocytic leukemia (CLL). The prevalence of this population ranges between 2 and 22 per 100,000 persons in Canada and varies by region. Until recently, fixed-duration fludarabine-based chemoimmunotherapy (CIT) was the primary treatment option in Canada for this patient population. The ECOG1912 trial has since demonstrated that ibrutinib and rituximab therapy are as effective as fludarabine-cyclophosphamide-rituximab (FCR) in this population. The ALLIANCE trial showed that rituximab added no incremental benefit to ibrutinib. Canadian payors and physicians adopted ibrutinib monotherapy as the CLL standard of care, even in the young, fit population, although frontline ibrutinib therapy is often reimbursed by provincial public drug plans only in patients with high-risk disease or those who are unfit to receive fludarabine. Young, fit patients with CLL and their physicians may now choose between continuous ibrutinib monotherapy and fixed-duration CIT with FCR. Factors affecting this choice include patient preference and the short- and long-term toxicity profiles of both regimens, and a risk-based algorithm is provided. As new continuous-therapy options enter the market, all treatment choices present benefits and risks that must be communicated to the patient. MDPI 2021-09-30 /pmc/articles/PMC8534822/ /pubmed/34677244 http://dx.doi.org/10.3390/curroncol28050326 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Costello, Jacqueline
Kang, Matthew
Banerji, Versha
Frontline Treatment of the Young, Fit Patient with CLL: A Canadian Perspective
title Frontline Treatment of the Young, Fit Patient with CLL: A Canadian Perspective
title_full Frontline Treatment of the Young, Fit Patient with CLL: A Canadian Perspective
title_fullStr Frontline Treatment of the Young, Fit Patient with CLL: A Canadian Perspective
title_full_unstemmed Frontline Treatment of the Young, Fit Patient with CLL: A Canadian Perspective
title_short Frontline Treatment of the Young, Fit Patient with CLL: A Canadian Perspective
title_sort frontline treatment of the young, fit patient with cll: a canadian perspective
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534822/
https://www.ncbi.nlm.nih.gov/pubmed/34677244
http://dx.doi.org/10.3390/curroncol28050326
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