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Optimizing CLL Therapy: Strategies for Dose Escalation and Reduction

Optimizing CLL Therapy: Strategies for Dose Escalation and Reduction from Patient Empowerment Network on Vimeo.

What’s the reasoning behind CLL therapy dose escalation and dose reduction? Expert Dr. Andres Chang from Emory University discusses common treatment scenarios when dose escalation and dose reduction are used in CLL patient care. 

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Transcript:

Dr. Nicole Rochester:

As the treatment landscape evolves for CLL, for some patient populations that need therapy, what is the rationale and evidence behind both dose escalation and dose reduction?

Dr. Andres Chang:

Well, so I think that the question of whether to dose-escalate or dose-reduce really depends on the treatment we’re talking about. For new therapies like BCL-2 inhibitors such as venetoclax (Venclexta), we do dose escalation at the beginning of therapy to mitigate potential side effects such as tumor lysis syndrome, whereas in most of the other scenarios we will try to do dose reductions in order to mitigate adverse events.

In all of these patients and in all of these cases, we do take into account the patient’s comorbidities. In the case of venetoclax, for instance, we think of whether patients have kidney dysfunction, and in the case of BTK inhibitors whether they have concomitant heart disease, hypertension, whether they are on anticoagulation, and also we take into account what other medications they have, in particular whether they have medications that affect their cytochrome P450 system.

Dr. Nicole Rochester:

Is there anything specific that you think healthcare providers need to know with regard to dose escalation and dose reduction?

Dr. Andres Chang

So dose escalation in terms of venetoclax initiation is, we already have a pretty well-established protocol that is on the label of the medication, and this is really mainly to mitigate the risk of tumor lysis syndrome. And in terms of dose reduction, I think it really depends again on which therapy we are talking about and also on which particular side effect we’re talking about.

And so I really encourage all the providers to really inquire and look into what potential side effects the patient might have so that you can adequately address this, because each side effect can be addressed or should be addressed with a different kind of strategy.


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