What is the goal of therapy for CLL?

Really, the goal of therapy is to get patients into a remission and hopefully a very long lasting remission. And again, these remissions last for years, but maybe just as obviously important as that is a remission whereby the patients are still feeling well and have a very good quality of life.

You know, most of these folks are, if they were working full time before or continuing to work full time, probably their folks, their friends at work don't even realize that they have a disease or are getting therapy. That's how well-tolerated most of the therapies are for most patients. So the goal is remission, long lasting remission, and good quality of life during all that time.

It really is incredible. And again, ten years ago and certainly 20 years ago, it was a different story. 20 years ago, we were using aggressive chemotherapy for many of these patients, and it probably would have been difficult to be living your life fully during that time. So these advances, miraculous is not an exaggeration. I mean, what's a miracle? A miracle is anything that you thought wasn't possible. You know, splitting an ocean seems like it wouldn't be possible. That's a miracle. You know, making people live long, healthy lives with very few side effects with the therapy seems pretty close to miraculous to me.

So the goal of therapy among our patients is like to be able to live the longest and the most functional life, to have the least amount of treatments and to have the safest set of treatments. So the sum total of these three points are very important.

Once you have seen that this is a CLL which needs a more aggressive treatment, then the oncologist and the patients determine what are the side effects and how aggressive that chemotherapy combination needs to be and for how long. And what are the side effects one can possibly find in those and then how long they have to be treated so that the toxicities don't affect their day to day affairs, day to day work as much. And then sometimes it is useful to have a treatment which might sound a little toxic upfront, but can clear out the cancer and lead to a much more prolonged remission period.

So those are the kind of treatments that discussions that the patients should have about treatments with their oncologist.

The goal of therapy in CLL depends on the type of therapy employed because certain classes of drugs do not produce deep remissions, as we said, BTK inhibitors and just a prolonged remission as possible, with even a partial remission state. Whereas with the class of drugs like BCL-2 inhibitors like venetoclax, depth of remission does seem to correlate with duration of remission.