All-Oral Fixed-Duration Doublets and MRD in Treatment-Naive CLL

Sameh Gaballa, MD, of Moffitt Cancer Center, asks whether the approval of all-oral fixed-duration acalabrutinib plus venetoclax has changed practice. Andrew H. Lipsky, MD, of Columbia University Irving Medical Center, notes that the AMPLIFY oral doublet produced progression-free survival in the mid-70% range at 3 years and that he wants longer follow-up; the zanubrutinib plus venetoclax option in guidelines is measurable residual disease (MRD) adapted and not yet approved. He welcomes regimens that avoid obinutuzumab but is not a triplet person, citing COVID-19 deaths in AMPLIFY, with a possible exception for a patient with a TP53 aberration who wants time off therapy. M. Yair Levy, MD, of Texas Oncology–Baylor Charles A. Sammons Cancer Center, views MRD as a reasonable surrogate with B-cell lymphoma 2 inhibitors and antibodies, and lists the appeals of fixed duration: fixed cost, fixed side effects, psychological benefit, possible disease eradication in favorable-risk disease, and the ability to reuse the regimen at relapse.