Which Drug Therapy for CLL, Time-Limited or Continuous?

This article was originally published by Medscape

About two thirds of patients who are diagnosed with chronic lymphocytic leukemia (CLL) are initially managed with a ‘watch-and-wait’ approach, but other one third of patients will need to be started on drug therapy straight away. But with which regimen?

The standard therapy to date has been time-limited chemoimmunotherapy, and this still has a key role to play in certain cases. But evolving continuous treatments and evidence on the array of factors that can influence response are making decision-making more individualized than ever, said Matthew S. Davids, MD, MMSc, director of clinical research in the Division of Lymphoma at Dana-Farber Cancer Institute and associate professor of medicine at Harvard Medical School, Boston, Massachusetts.

“Continuous versus time-limited treatment discussions are long discussions now and should be individualized to particular patients and their comorbidities,” said Davids.

Davids was speaking at a “How I Treat” session at the recent American Society of Hematology’s (ASH) Meeting on Hematological Malignancies, which was held virtually because of the COVID-19 pandemic.

Key Factors to Consider

Key factors in determining the most effective approach are the patient’s TP53 and immunoglobulin heavy chain (IGHV) gene mutation status, Davids said.

For instance, the traditional choice for frontline care for CLL has been standard chemoimmunotherapy (eg, fludarabinecyclophosphamide and rituximab [FCR]), with a typical treatment duration of 6 months. However, the response effects appear most durable in younger patients with mutated IGHV and intact TP53.

As evidence, Davids cited data from a long-term follow-up of one of the original FCR studies in 300 patients, which found that about 60% of patients had long-term disease-free survival.

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