Time-limited therapy for CLL and lymphoma – who, what, and how?

During the Lymphoma Hub Steering Committee meeting, Francesc Bosch chaired a discussion on: Time-limited therapy for chronic lymphocytic leukemia (CLL) and lymphoma – who, what, and how? This discussion also featured Gilles Salles, Grzegorz Nowakowski, Andrew Davies, Kieron Dunleavy, Marek Trněný, Miles Prince, Alison Moskowitz, and Astrid Pavlovsky. The panel discussed the advantages, disadvantages, and important considerations for time-limited versus continuous therapy in both CLL and lymphoma.

Time-limited versus continuous therapy in DLBCL

The first topic discussed was time-limited versus continuous therapy of bispecifics in diffuse large B-cell lymphoma (DLBCL), such as gloflitamab versus epcoritamab. Moskowitz and Salles highlighted that complete response (CR) rates and the stage of disease are important factors when choosing continuous versus time-limited therapy, as those achieving CR in earlier stages could warrant the stopping of treatment, whereas those achieving CR after multiply-relapsed disease could be more inclined to continue therapy. Nowakowski mentions that the optimal approach is dependent on the clinical scenario, as continuous therapy may be beneficial in the relapsed/refractory setting given the limited treatment options. Davies points out that there is emerging data on the resistance to bispecifics in DLBCL, and Trněný mentions the importance of patient preference in decision-making.  

Key questions in the use of continuous therapy in DLBCL include:

• What would happen if therapy is stopped and re-exposed following progression?
• What are the long-term bispecific-related toxicities in DLBCL?

Time-limited versus continuous therapy in CLL

The second topic of discussion was time-limited versus continuous therapy in CLL, such as venetoclax versus Bruton’s tyrosine kinase inhibitors. Pavlovsky and Prince highlighted that patient preference and age is key in this decision. Dunleavy mentioned that there is ongoing data on the role of genetics for therapy selection in CLL.

A key question in CLL is:

• What are the outcomes to further lines of therapy following time-limited therapy in younger patients?

Overall, the key considerations in whether to choose continuous versus time-limited therapy include patient preference, stage of disease, genetics, toxicities, and age.