Venetoclax in patients with relapsed or refractory chronic lymphocytic leukaemia

Therapies targeting the B-cell receptor (ie, B-cell receptor inhibitors) are a welcome addition to chronic lymphocytic leukaemia and small lymphocytic lymphoma management. It has shifted the treatment paradigm from one of active chemotherapy to chronic care. 1 Jain N O'Brien S Initial treatment of CLL: integrating biology and functional status. Blood. 2015; 126: 463-470 Crossref PubMed Scopus (0) Google Scholar The ease of administration, without the constraints on age and fitness for chemotherapy, combined with predictable short-term and long-term toxicity profiles, makes B-cell receptor inhibitors an attractive therapy for many patients. Importantly, this class of oral agents has improved equity and access of treatments in all age groups and geographical regions. 2 Lachaine J Guinan K Aw A Banerji V Fleury I Owen C Impact of fixed-duration oral targeted therapies on the economic burden of chronic lymphocytic leukemia in Canada. Curr Oncol. 2023; 30: 4483-4498 Crossref PubMed Scopus (5) Google Scholar However, what emerged were new types of toxicities due to off-target effects. 3 Banerji V Aw A Robinson S Doucette S Christofides A Sehn LH Bruton tyrosine kinase inhibitors for the frontline treatment of chronic lymphocytic leukemia. Curr Oncol. 2020; 27: e645-e655 Crossref PubMed Scopus (2) Google Scholar Furthermore, the low rates of complete responses, due to the inability to reach deep responses within the bone marrow, often leads to the need for continuous therapy. Continuous therapy necessitated ongoing monitoring of toxicities and often results in eventual relapse due to drug-resistant mutations or discontinuation of therapy due to intolerance. 4 Eyre TA Riches JC The evolution of therapies targeting Bruton tyrosine kinase for the treatment of chronic lymphocytic leukaemia: future perspectives. Cancers (Basel). 2023; 152596 Crossref PubMed Scopus (4) Google Scholar Activity of venetoclax in patients with relapsed or refractory chronic lymphocytic leukaemia: analysis of the VENICE-1 multicentre, open-label, single-arm, phase 3b trialThese data demonstrate deep and durable responses with venetoclax monotherapy in patients with relapsed or refractory chronic lymphocytic leukaemia, including BCRi-pretreated patients, suggesting that venetoclax monotherapy is an effective strategy for treating BCRi-naive and BCRi-pretreated patients. Full-Text PDF Open Access