Topline  Presentation Points

Recognize indications to treat and interpret the molecular profile to inform treatment initiation. 

Treatment decisions and the Canadian Perspective 

  • Informed by Age, Fitness and Kidney Function 
  • CADTH Provisional Funding Algorithm Diagram for CLL
  • CADTH Reimbursement Review. Provisional Funding Algorithm for Chronic Lymphocytic Leukemia. Final Report. May 18, 2021.
  • [Select] Trial data add further context (ECOG 1912, CLL14, ELEVATE-TN, ALLIANCE) 
  • BTKi Have Shown Favourable Efficacy Against del(17p)/TP53 Aberrations in Patients With TN CLL 
    • Patients with TP53 mutation or del(17p) should receive front line therapy with BTKi 
  • Targeted Therapies Have Shown Efficacy Against Unmutated IGHV in Patients with TN CLL 
    • High risk – Ibrutinib or acalabrutinib 
    • Low risk options  –  Venetoclax+Obinutuzumab,  BR, Chlorambucil+Obinutuzumab, FCR  

Should we watch and wait – Update from Canadian Cancer Trial Group (EVOLVE CLL/SLL STUDY)
RANDOMIZED, PHASE III STUDY OF EARLY INTERVENTION WITH VENETOCLAX AND OBINUTUZUMAB VERSUS DELAYED THERAPY WITH VENETOCLAX AND OBINUTUZUMAB IN NEWLY DIAGNOSED ASYMPTOMATIC HIGH-RISK PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA (CLL/SLL): EVOLVE CLL/SLL STUDY 

  • Hypothesis that early intervention with VO will improve the rate of 6-year OS from 60% to 80%.