Dr. Shadman on Fixed Durations of Treatment in CLL

Mazyar Shadman, MD, MPH, assistant member, Clinical Research Division, Fred Hutchinson Cancer Research Center, assistant professor, Medical Oncology Division, Department of Medicine, University of Washington School of Medicine, and attending physician, Seattle Cancer Care Alliance, discusses fixed durations of treatment in chronic lymphocytic leukemia (CLL).

Last year, many patients would likely opt for a chemoimmunotherapy regimen as opposed to an oral drug like ibrutinib (Imbruvica) because it is a fixed duration of treatment, says Shadman. After approximately 6 months, patients could enjoy their remission off treatment, which could last for years.

Now, patients have the added option of considering a nonchemotherapy drug that gives them the opportunity of potentially having a fixed duration of treatment. However, this is not a guarantee because studies, such as CLL14 or MURANO, were designed to give venetoclax (Venclexta) in combination with a CD20-targeted antibody for 1 and 2 years, respectively. It is not yet known what happens after these patients stop treatment. In the phase III MURANO study, there are short-term data to suggest that patients who achieve a deep remission may be relapse-free for a long time.

Just the fact that the field can have conversations regarding the potential of getting patients to a treatment-free and disease-free timepoint is promising in and of itself, says Shadman. Not only is time-limited treatment important for a patient, but it is also significant for physicians and the health system. This opportunity was never possible with BTK inhibitors or PI3K inhibitors, as these drugs are not designed to induce deep remissions that could translate to long-term remissions. Venetoclax may change that, adds Shadman, although longer follow-up data are needed.