iwCLL 2023 | Choosing between continuous versus fixed-duration therapy in CLL

That’s a very tough decision, especially in first line, I mean. We are taking into account on one side CLL related features, including presence or absence of Tp53 aberrations, immunoglobulin gene mutation status, but on the other side, we should also take into account relevant comorbidities and, of course, patient preferences. So we have to balance some pros related with the administration of continuous BTK inhibitors on one side, that are generally well tolerated and can be taken orally as continuous treatment, on the other side, and nowadays as fixed-duration regimen, we have in Europe, the combination of venetoclax plus obinutuzumab (the administration of obinutuzumab is a 12 month duration regimen) and recently we also have the combination of venetoclax plus ibrutinib which was approved and is available as a fixed-duration treatment in many countries in Europe. So basically, the most relevant factor in driving the treatment choice at the beginning is the presence of Tp53 aberrations. If patients are carrying Tp53 aberration, I would generally go for a continuous treatment with the BTKi, unless more solid data in the next future with the combination of venetoclax plus ibrutinib, are suggesting that we can achieve long term disease control with this combination, even in this very high risk category of patients. Otherwise, for patients carrying unmutated immunoglobulin genes or mutated immunoglobulin genes, I would consider both options and discuss with the patients the most convenient scheme or design.