Dr. Awan on Time-Limited Treatments in CLL

Farrukh Awan, MD, associate professor, Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, and member, Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center and William P. Clements Jr. University Hospital, UTSW, discusses the need for time-limited treatments in patients with chronic lymphocytic leukemia (CLL).

Many patients with CLL do not want to take lifelong treatment, says Awan. The issue with BTK inhibitors is that although these agents induce very good responses in patients with CLL, the responses are not deep; this means that patients will need to continue on therapy indefinitely until their disease stops progressing. A stopping rule for BTK inhibitors in CLL does not exist, says Awan, although strategies to limit the duration of therapy are currently under investigation.

One of the major advances made in CLL in recent years has been the introduction of venetoclax (Venclexta) into the treatment paradigm. This agent has proved to perform better in a time-limited setting compared with other drugs, according to Awan.

For example, the phase III CLL14 trial demonstrated the superiority of fixed-duration treatment with venetoclax plus obinutuzumab (Gazyva) versus chlorambucil/obinutuzumab in untreated patients with CLL. Additionally, the phase III MURANO trial showed that when the agent was used in combination with rituximab (Rituxan), patients with relapsed/refractory disease had significantly higher rates of progression-free survival compared with bendamustine plus rituximab.

These data suggest that venetoclax can be used as a time-limited option in patients with CLL. Depending on the situation, patients will only have to receive treatment for 12 or 14 months rather than indefinitely. Not only does this option induce very deep responses in the vast majority of patients, but it is also results in deep remissions, says Awan. The hope is that the remissions will last a long time and patients will not need to receive chemotherapy at all, concludes Awan.