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Venetoclax Shows Promise for Elderly CLL Patients, Study Reveals
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A recent study published in *blood Advances* highlights the effectiveness of venetoclax (Venclexta) in treating chronic lymphocytic leukemia (CLL) among elderly patients, specifically those over 80. While the drug demonstrates a high response rate, clinicians should be prepared for potential treatment management challenges, including temporary interruptions (CLL).
High Response Rate with Venetoclax in Octogenarians
The retrospective study, conducted across 23 Italian medical centers between 2014 and 2023, involved 120 patients over the age of 80. The findings revealed a 91% overall response rate in this age group, which is comparable to results seen in younger CLL patients. This suggests that venetoclax can be a viable treatment option even for the oldest patients battling CLL.
Did You Know? The median age at diagnosis for CLL is 70 years old, and over a quarter of patients are between 75 and 84 years old when diagnosed national Institutes of Health.
Study Details and Patient Characteristics
The study population had a median age of 81 years at the start of venetoclax therapy. A significant portion of the patients had existing health issues, with 54% having Cumulative Illness Rating Scale scores above 6. Additionally, 53% had impaired kidney function, and a substantial number where at intermediate or high risk of tumor lysis syndrome. Most patients (83%) had relapsed or refractory disease, having undergone a median of two prior lines of therapy.
Treatment Regimens
The patients received venetoclax either as a monotherapy (50%), in combination with rituximab (45 patients), or in combination with obinutuzumab (17 patients).
Efficacy and Safety Profile
The study indicated that venetoclax showed “remarkable efficacy” in the elderly patient group, with a complete response rate of 44% and a progression-free survival of 44 months. Though, the researchers also noted common side effects, including neutropenia (37%) and grade 3 or higher infections (22%).
Pro Tip: Careful patient management is crucial when administering venetoclax to elderly patients. Clinicians should be prepared for potential dose adjustments and temporary treatment interruptions.
Management Challenges and Dose Adjustments
The study highlighted the importance of patient management during venetoclax treatment. Approximately 32% of patients required a ramp-up time exceeding five weeks, and only 78% eventually reached the full 400-mg dose. Furthermore, 43% of patients needed temporary treatment interruptions lasting at least seven days.
Comparison with BTK Inhibitors
Researchers compared the venetoclax findings with data from a similar group of patients treated with Bruton tyrosine kinase inhibitors (BTKis). While both treatments showed comparable overall efficacy,venetoclax had a higher rate of complete responses. The safety profiles differed,with BTKis showing higher rates of cardiovascular toxicities (26% vs. 4%) and venetoclax showing higher rates of infectious events (82% vs. 49%). However,rates of grade 3 and 4 infections were similar between the two groups.
| Treatment | Overall Response Rate | Complete Response Rate | Cardiovascular Toxicities | Infectious Events |
|---|---|---|---|---|
| Venetoclax | 91% | 44% | 4% | 82% |
| BTK Inhibitors | Comparable | Lower | 26% | 49% |
It’s vital to interpret these comparisons cautiously due to differences in patient characteristics, such as a higher proportion of patients with
