Which Patients Are Best Suited for Fixed-Duration Therapy in CLL

Andrew H. Lipsky, MD, of Columbia University Irving Medical Center, describes his ideal candidate for fixed-duration therapy in treatment-naive chronic lymphocytic leukemia (CLL). Citing data presented at the European Hematology Association meeting showing a median progression-free survival of about 9 years for patients with mutated immunoglobulin heavy chain variable region (IGHV) disease after 1 year of venetoclax plus obinutuzumab in CLL14, he favors time-limited therapy for IGHV-mutated patients who value time off treatment, while his frailest patients still receive continuous Bruton tyrosine kinase (BTK) inhibition. M. Yair Levy, MD, of Texas Oncology–Baylor Charles A. Sammons Cancer Center, adds a cost perspective, describing an analysis in which continuous BTK inhibitor therapy cost several hundred thousand dollars per quality-adjusted life-year compared with a sequential approach. Asked by Sameh Gaballa, MD, of Moffitt Cancer Center, whether convenience or efficacy drives the conversation, Dr Levy says both matter, and expects some favorable-risk patients to reach a functional cure.