Brown JR, et al. - In the setting of relapsed or refractory chronic lymphocytic leukemia (R/R CLL), researchers assessed the clinical benefit:risk balance for idelalisib (IDELA, a first-in-class PI3Kδ inhibitor) in early vs later lines of use in order to determine if early line use of IDELA may also lead to inferior clinical outcomes. According to the findings, the use of IDELA + α-CD20 regimens as 2nd line vs later lines, after chemo-immunotherapeutic regimens, resulted in comparable or improved efficacy and a similar safety profile in the setting of R/R CLL. In patients treated with IDELA in the 2L (given in the second line setting), longer progression-free survival and overall survival were noted which may indicate shorter time since diagnosis, lower stage disease, or less disease resistance, but also imply greater efficacy benefit which could better offset potential toxicity in this patient sub-group. For patients with R/R CLL after chemo-immunotherapy, the use of IDELA + α-CD20 in the 2L+ setting is supported in this study.