ASH 2024 | The management of CLL within the UK’s NHS framework

I think we’re lucky actually within the NHS that we’re able to access nearly all of the licensed treatments in both the frontline and relapsed setting using the newer agents. In frontline, we have access to the perhaps more traditional continuous monotherapies, certainly both acalabrutinib and zanubrutinib are now both established as a very go-to regime for your frontline patients particularly those ones who perhaps are a little bit older perhaps want the ease and convenience of having a single monotherapy a tablet at home certainly doesn’t require too much monitoring to commence treatment which I think can be attractive. However, I think we’re increasingly going towards the fixed duration therapies and we’re using both fixed duration ibrutinib-venetoclax and fixed duration venetoclax-obinutuzumab, both well-established reimbursed licensed regimes. I think those continue to sort of have equal balance of those patients who go through combination therapy where you’re likely just to see perhaps more side effects when you’ve got two drugs rather than one at the initial phase and the need to attend hospital for the obinutuzumab infusions or the venetoclax ramp up. But they have the attractiveness that those patients will come off therapy, and I think that can be desirable for patients. So important to have a very good, thorough discussion with patients about everything, about their disease, about other medical conditions they might have or reasons to choose therapy. But ultimately, in nearly all cases, it’s down to what suits the patient best. I think the major exception to that is if they’ve got a genomically very high risk disease, and I would include those patients with p53 disruption, where you might favour a longer duration treatment than the current fixed duration treatments in terms of improved PFS. But I think that’s a discussion you should have with patients and expectations. And I don’t think any of the available treatments that we use today, which does not include any form of chemoimmunotherapy, should necessarily be excluded.

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