CARE™ CLL Discussion Series - Part 2

Shared Decision Making and Incorporating Patient Goals in Frontline CLL Treatment Decisions

Hematology

06 Dec 2021

Introduction

In this segment of the CLL Discussion series CARE™ Hematology Faculty members Dr. Julie Stakiw (Saskatoon Cancer Centre)  and Carolyn Owen (University of Calgary) discuss how patient goals are considered and their approach to shared-decision making.

Discussion Summary/Highlights

What is your current approach for determining optimal frontline treatment?

  • Whether patient requires therapy (most difficult decision).
    • There are clinical trials ongoing that are investigating use of novel therapy for asymptomatic, but as of now it is only recommended to start treatment in symptomatic patients.
  • Age is becoming less important
  • Other factors: IVHG mutation status, del17p, TP53 mutations (testing not routinely available across Canada)
  • It is a longer conversation with patients now and also includes patients preferences (i.e. in terms of treatment duration, oral vs. not, funding, etc.)

What recent data in the frontline setting do you anticipate will impact your approach?

  • GLOW- CO vs. Ibrutinib plus Venetoclax fixed-duration (NCT03462719)
    • Data indicates deep remission and impressive PFS
    • This would be a particularly interesting regimen for younger, fitter patients (not included in this trial. May have to extrapolate from CAPTIVATE Trial)

How do you incorporate shared decision making considering patients goals in your frontline practice?

  • We have our own goals so we have to match in the middle with what is important to them
  • COVID and use of video consultations have made this conversation more challenging (especially in older patients).

In your experience, what is considered optimal treatment by your patients?

  • This is really variable given the heterogeneity of the CLL population
  • In general, response rate, survival benefit, increase in QoL (both during and after), and time to next treatment come into play.

What factors are most important to discussion prior to making a treatment decision?

  • Conversations should consider preference of treatment duration, what prognostic features the patient has are, patient geography, funding and private coverage, etc.
  • We must also ensure that the patient understands the importance of adherence in initial conversations about their treatment.