Reassessing the role of chemoimmunotherapy in chronic lymphocytic leukemia

Introduction: The treatment paradigm of chronic lymphocytic leukemia (CLL) has changed significantly in the last few years. There are multiple front-line therapy options for the treatment of CLL, including chemoimmunotherapy (CIT), ibrutinib, and most recently venetoclax with obinutuzumab. The role of CIT has declined significantly for patients with CLL and novel agents are now being used more frequently in the front-line setting.Areas covered: Authors reviewed the latest data examining the role of CIT versus ibrutinib and ibrutinib combined with CIT for the treatment of CLL. Data reviewed here include: preliminary results from CLL12, long-term results of CLL8 and MD Anderson Cancer Center (MDACC) data with FCR, 7-year follow-up of PCYC-1102/1103 (phase 2 data) with ibrutinib, results of two-phase 3 randomized trials comparing CIT to ibrutinib, E1912 and A041202, and results of HELIOS and other phase 2 trials evaluating CIT combined with ibrutinib.Expert opinion: Treatment approaches for patients with CLL should be individualized and that there is still a role, albeit diminished, for CIT in the treatment of CLL, predominately in the front-line setting. Clinicians should focus on prognostic factors, patient preference, and evaluate short and long-term effects of CIT versus novel agents. Newly diagnosed patients should be encouraged to enroll in clinical trials.