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Fixed-duration vs continuous therapy

aka fixed-duration, fixed duration, time-limited, time-limited therapy, finite therapy, continuous therapy, continuous treatment, indefinite treatment, treatment-free, treatment-free interval, treatment-free survival, off-treatment, treatment discontinuation, stopping rules, stop trial, treatment cessation, elective discontinuation

Whether a drug is taken for a set period (say 12 months) and then stopped even though it is still working, or continued indefinitely until it fails. Fixed-duration gives patients years off treatment; continuous therapy avoids the risk of the cancer regrowing.

The debate is sharpest in CLL, where venetoclax-based regimens for 12-15 months (CLL14, GLOW) compete with indefinite BTK inhibitors, and MRD status at the end of therapy predicts who stays in remission. In CML, treatment-free remission after deep response is established; in myeloma, lenalidomide maintenance is continuous but MRD-guided stopping trials are under way; in metastatic melanoma and lung cancer, immunotherapy is often stopped at two years with durable benefit (KEYNOTE-006, CheckMate 153). Fixed-duration reduces cumulative toxicity and cost and permits retreatment; continuous therapy is simpler to prove in trials because progression-free survival keeps counting.

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Treatment jargon

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