What factors do you take into account for recommending venetoclax/obtinutuzumab vs BTK inhibitors vs chemotherapy in front line therapy for CLL?

For most patients, either BTK inhibitor or venetoclax/obinutuzumab would be appropriate therapies. I would only consider chemotherapy (fludarabine/cyclophosphamide/rituximab) for those <65 years old with IGHV mutated disease and no high risk genetic markers. And even in these patients, I almost alwa...

The factors influencing treatment decision includes the age of the patient, comorbidities, renal function, genomic status (IGHV mutation status; deletion 17p, TP53 mutation).

Chemoimmunotherapy is restricted to young fit patients with no major comorbidities and with IGHV mutated CLL without deletion...

I generally no longer use chemoimmunotherapy (CIT) for frontline CLL therapy in my practice. E1912 showed an OS benefit of ibrutinib based therapy vs FCR in younger patients. While most other novel agents vs CIT frontline trials have not shown an OS benefit, I personally see no strong reason to expo...

If IGHV is mutated, my choice is neither BTK nor Venetoxlax+ Obinituzumab but it is chemoimmunotherapy. As a general oncologist, we utilize way more difficult chemotherapy regimens than FCR or Bendamustine Rituxan in older than age 65 group of patients. If the oncologist is familiar with his chemoth...

Typically, this is a long discussion about the options with every patient. Some specific disease features are critical. For example, for patients whose CLL has 17p deletion or TP53 mutation, I tend to favor BTK inhibitors based on current data, which suggest that relapse may be earlier after time li...