A new survey of community physicians has revealed key insights into the adoption patterns and challenges surrounding venetoclax treatment for chronic lymphocytic leukemia (CLL), highlighting significant barriers to implementing fixed-duration therapy in clinical practice.
The study, led by Dr. John Burke of SCRI at Rocky Mountain Cancer Centers, surveyed 103 oncologist-hematologists and advanced practice providers with extensive CLL treatment experience. The findings shed light on the complexities of venetoclax implementation in community settings.
Treatment Initiation Challenges
The survey identified three primary concerns among healthcare providers regarding venetoclax initiation. Tumor lysis syndrome (TLS) management and monitoring emerged as the foremost challenge, followed by clinical logistics and the need for rapid laboratory test processing. To address these issues, providers have implemented various strategies, with patient and staff education being the most commonly cited solution.
"We educated the patients, the staff, and themselves about how to do this correctly," noted Dr. Burke. Additional measures included establishing protocols for expedited laboratory processing and providing detailed treatment calendars to patients.
Current Prescribing Patterns
Despite venetoclax's availability as a fixed-duration option, the survey revealed that less than half of experienced providers regularly prescribe it compared to other treatment options. Only about one-third of oncologists use fixed-duration therapy for the majority of their patients, suggesting a continued preference for alternative treatments such as BTK inhibitors.
Patient Selection Considerations
The study highlighted important factors in patient selection for venetoclax therapy. Dr. Burke emphasized that ideal candidates include:
- Patients living in close proximity to clinical facilities
- Those with cardiac conditions that may preclude BTK inhibitor use
- Individuals able to maintain consistent follow-up during the initial treatment phase
Future Treatment Landscape
Recent developments, particularly the AMPLIFY study presented at ASH, suggest potential expansion of treatment options. The study investigates a fixed-duration combination of acalabrutinib and venetoclax as frontline CLL treatment, potentially offering an all-oral alternative to current regimens.
Economic Implications
The survey findings carry significant implications for healthcare costs. As Dr. Burke points out, "If physicians keep a patient on a BTK inhibitor for 7 or 8 years, that's going to be more expensive than 1 year of fixed-duration therapy." This cost differential presents an important consideration for both healthcare providers and payers.
Safety and Risk Management
Recent studies have demonstrated that when venetoclax is administered according to package insert guidelines, particularly when combined with obinutuzumab, the risk of TLS is notably low. This finding suggests that proper protocol adherence can effectively mitigate safety concerns that may be deterring some physicians from prescribing the treatment.
