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iwCLL 2025 | MRD-guided ibrutinib-venetoclax versus ibrutinib or FCR for previously untreated CLL: FLAIR trial
Talha Munir, MBBS, MRCP, FRCPath, PhD, Leeds Teaching Hospitals NHS Trust, Leeds, UK, discusses findings from the FLAIR trial (ISRCTN01844152), stating that ibrutinib plus venetoclax administered for a measurable residual disease (MRD)-guided duration of treatment is superior to both continuous ibrutinib monotherapy and fludarabine-cyclophosphamide-rituximab (FCR) chemoimmunotherapy in previously untreated chronic lymphocytic leukemia (CLL). Dr Munir highlights that this time-limited approach may be particularly beneficial for patients with unmutated IGHV status. This interview took place at the biennial International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2025 in Krakow, Poland.
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Transcript
The FLAIR trial is a trial which has been running for some time. We are reporting the outcomes of MRD-driven ibrutinib-venetoclax treatment in patients. This has been compared to continuous therapy in the form of ibrutinib and also in comparison to chemoimmunotherapy. What it’s showing is that ibrutinib-venetoclax given in an MRD-driven way between two to six years of total duration of therapy was superior to continuous Ibrutinib therapy as well as chemoimmunotherapy...
The FLAIR trial is a trial which has been running for some time. We are reporting the outcomes of MRD-driven ibrutinib-venetoclax treatment in patients. This has been compared to continuous therapy in the form of ibrutinib and also in comparison to chemoimmunotherapy. What it’s showing is that ibrutinib-venetoclax given in an MRD-driven way between two to six years of total duration of therapy was superior to continuous Ibrutinib therapy as well as chemoimmunotherapy. We saw a progression-free survival advantage as well as overall survival advantage for patients treated this way.
The main benefit that we found in the subgroup analysis was the unmutated IGHV patients which benefited the most from this way to deliver Ibrutinib-venetoclax. I think the impact of these findings really will be towards the unmutated IGHV patients. I think this is a regimen which, if delivered in this way for unmutated IGHV patients, is very beneficial. And this is the first trial which is actually showing a superiority of this approach as compared to the continuous therapy. And what we also are finding is an overall survival advantage, which is very difficult to see in a frontline study at five years output. So I think there is a lot of benefit and it may be the right course to be taken for unmutated IGHV patients.
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