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iwCLL 2025 | The optimal duration of time-limited BTKi plus BCL2i combination therapies in CLL
Moritz Fürstenau, MD, University Hospital of Cologne, Cologne, Germany, comments on the optimal duration of time-limited BTK inhibitor (BTKi) plus BCL2 inhibitor (BCL2i) combination therapy in chronic lymphocytic leukemia (CLL), noting that there is insufficient data to come to a consensus on this topic. Although data from the FLAIR trial support the use of longer treatment durations, Dr Fürstenau favors shorter treatment to avoid the emergence of resistance mutations and additional toxicities. This interview took place at the biennial International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2025 in Krakow, Poland.
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Transcript
That’s a very tricky one, because I think the whole CLL community is not quite sure about or there’s no common understanding of how long treatment with ibrutinib and venetoclax, for example, or other BTK inhibitors and BCL2 inhibitors should be. There are certain approaches that actually do an indefinite treatment of both. Then there are others that actually are approved that only do it for a bit more than a year...
That’s a very tricky one, because I think the whole CLL community is not quite sure about or there’s no common understanding of how long treatment with ibrutinib and venetoclax, for example, or other BTK inhibitors and BCL2 inhibitors should be. There are certain approaches that actually do an indefinite treatment of both. Then there are others that actually are approved that only do it for a bit more than a year. And I personally am more in favor of shorter treatments because I think it prevents resistance mutations. It prevents added toxicities with longer exposure. But it’s really hard to ignore the FLAIR data, because in the FLAIR trial they showed PFS rates that we’ve never seen before, like 95%, 94% after a few years, and they obviously do longer treatment. I think the median treatment duration was around three years. For me, as a doctor treating CLL patients, this would be too long. I would really prefer the shorter fixed-duration treatment for about a year.
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