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Editorials
ment choices. TP53 aberrations, del(17p) and/or mutated TP53, indicate benefit from treatment with novel agents over chemoimmunotherapy but also remain associated with earlier progression in patients treated with targeted therapy.17,18 In the CLL14 trial that compared venetoclax with obinutuzumab to chlorambucil with obinutuzumab, mutated BIRC3, and SF3B1 mutations were independent adverse factors for outcome in the chemoimmunotherapy arm but not in the venetoclax arm.17 While formally not identified as predictive markers, BIRC3 and SF3B1 muta- tions, as well as TP53 aberrations would still reasonably guide patients to venetoclax based therapy over chemoim- munotherapy.
Asking for predictive markers for every treatment deci- sion may raise the bar too high. Solid data on the prognos- tic information of genetic markers for different types and lines of treatment should suffice in most settings. Especially, when access to, and tolerability of the pro- posed therapy are also considered. Mutation testing by NGS, once incorporated into clinical trials, will not only yield rich prognostic information but also provide a more granular resolution of the genetic risk profiles of the enrolled patient population. We are eager to use the tools, we shall learn how to best apply the data they generate to clinical decision making.
Disclosures
None
Funding
Support received for work outside the submitted work: Adrian Wiestner received research support from Pharmacyclics LLC, an AbbVie company; Acerta Pharma, a member of the Astra-Zeneca group; Merck; Nurix; and Genmab. The author is supported by the intramural research program of NHLBI, NIH.
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