Jurnal Internasional Kombinasi atau urutan agen yang ditargetkan dalam CLL: apakah keseluruhan lebih besar dari jumlah bagian-bagiannya (Aristoteles, 360 SM)?
Landscape treatment for chronic lymphocytic leukemia (CLL) is growing rapidly. Targeted agents (TAS) have shown impressive single agent activity and have therefore replaced chemoimmunotherapy (CIT). Apart from its efficacy, the optimal use of TA today remains challenging. Perhaps the main dilemma is whether this drug is best used in sequence or in combination. Most patients tolerate TA well, especially early during treatment; However, a large number stopped therapy because of toxicity. Therefore, the reason for termination and, subsequently, the order of the preferred agent is a critical problem. Although TA monotherapy has revolutionized CLL treatment, residual disease, acquired resistance, endurance of suboptimal responses in patients with high-risk diseases, unlimited duration of treatment, and decreased compliance over time is a concern. To overcome these challenges, more and more studies are evaluating various combinations of TA; However, this study is largely a small single arm trial in a heterogeneous patient population using different methods for response assessment. A number of questions remain regarding the predictive value of minimal residual disease status (MRD), response durability, duration of treatment, and importantly, criteria for patient selection for optimal combination. Medical comorbidity, performance status, prior therapy, and disease risk profile are fundamental in determining treatment plans for each patient. Furthermore, using prognostic and predictive markers along with monitoring MRD can guide the development of individual chemo treatment regimens that are more tolerant, time-limited, and potentially curative.