What goes into deciding if a fixed duration therapy or continual therapy is best for the patient?

So this is probably the hottest question in class today because it's so relevant. And there are a few features on an end today as of today, because things may change next month, is that you either start therapy with A, B taking A beta, and that is expect to be continued indefinitely or B or regimen. When you combine venetoclax with an antibody called OBINUTUZUMAB. And that combination is given for a period of 12 months. For the first six months, you get both agents, for the other six months you get just venetoclax. So that's a time limited therapy. You get that for 12 months.

So in the majority of times patients will be eligible for both. There are certain features that my guide you more towards one or the other, but the reality is that most patients can really be considered for both. There are certain features we talked before about immunoglobulin gene, have a gene rearrangement, so I g HIV mutations or mutated status can define a little bit if one agent is better than the other, the TP53 mutation or deletion. 17 B maybe there's also a difference between one or the other, but it's not that venetoclax is not really active in this group of patients.

So what I do with patients when we are discussing therapy, the time has come based on these treatments and we have those options. We try to put everything in perspective because when you're combining the venetoclax would have been a twosome. MAB The patient has to come to the office to get the infusion. So transportation might be an issue or distance to the center might be an issue. Patients may have drop in blood count, so they need more frequent labs. Are they going to get the labs? Are they able to get the labs more frequently? So that can be a problem.

So is usually is the bigger dedication to the therapy in the beginning. So a little bit more winter effort with the idea that over time, this effort will decrease. Usually the therapy gets easier after the first few cycles, less frequent visits, not as much infusions, less frequent labs. And then of the six months is just the pill. So you pay your price in the beginning and you have the chance of just getting 12 months of therapy and stopping versus the BTK inhibitor, which is easier to start, also has a different pattern of side effects. Some patients might not be the best ones. Some cardiovascular problems is not that. It's absolute. No, no. But sometimes we'll have to take that with a little more caution. But it tends to be a nice, easier thing. You start your pill and you take your pill, but you take your pill forever.

So when I'm discussing, I take into consideration these genetic features that may guide us. One agent may be better than the other because the genetic features, patient preference, what they are willing to do, what they want, and also these social issues. They may also help us on the proximity to a central distance and frequency and where they are in their life. So when we're discussing this, I say that Cielo is a lion trying to attack you. We either put a line in the cage, which is a BTK inhibitor. As long as you take the BTK inhibitor in the majority of times, the line is there, the lion is awake because we don't really have much deep responses would be inhibitors by themselves. So the lion is alive, but inside a cage, you stop the pill, you open the cage, the lion is out with venetoclax combinations.

You have deeper responses. So you put the line into sleep. So your dart, you put him to sleep. There's no cage. The lines, they're sleeping. And you can probably walk around for a while and Dylan will be there asleep. Eventually lan will wake up and then when he wakes up, you decide what to do. So it's a different approach to take care of. The line is trying to attack you, but it's not that straightforward. You need this, you need that is really defining which patient fits each treatment best.