Current Treatment Landscape for Treatment-Naive CLL
Panelist discusses how frontline CLL treatment has evolved from choosing between continuous oral therapy vs fixed-duration combination therapy to now including new all-oral fixed-duration regimens, explaining the advantages and disadvantages of each approach based on patient preferences.
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Chronic lymphocytic leukemia (CLL) treatment has evolved significantly with 2 primary therapeutic approaches available for frontline patients. Continuous therapy involves daily oral medications that patients take indefinitely, while fixed-duration therapy combines venetoclax pills with intravenous obinutuzumab for approximately 1 year. Recent ASCO presentations have introduced new all-oral combination regimens offering fixed-duration options, expanding the treatment landscape beyond the traditional “this or that” decision-making process.
The advantages and limitations of each CLL treatment approach depend heavily on patient preferences and lifestyle factors. Continuous therapy offers convenience through oral medication administration, allowing patients greater freedom to travel and maintain daily routines without frequent clinic visits. However, the indefinite treatment duration raises concerns about long-term adverse effects and quality of life impact. Fixed-duration therapy provides the benefit of treatment-free periods after completing the regimen, but requires more frequent initial monitoring and intravenous infusions, which may be challenging for patients with needle phobias or difficult venous access.
Treatment selection in CLL increasingly incorporates both patient preferences and disease characteristics, particularly cytogenetic factors that influence treatment response. While both continuous and fixed duration approaches have shown excellent efficacy in frontline CLL, emerging data suggests that patients with higher-risk genetic mutations may respond differently to various regimens. This personalized approach to CLL treatment selection ensures optimal outcomes by considering individual patient factors, disease biology, and treatment goals in the decision-making process.
