Comparison of different phase II studies using sequential combinations of targeted agents for treating chronic lymphocytic leukemia.

Authors

null

Von Tresckow Julia

Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany

Von Tresckow Julia , Paula Cramer , Jasmin Bahlo , Sandra Robrecht , Othman Al-Sawaf , Petra Langerbeins , Moritz Fürstenau , Anja Engelke , Anna-Maria Fink , Kirsten Fischer , Karl A Kreuzer , Matthias Ritgen , Sebastian Boettcher , Clemens Martin Wendtner , Stephan Stilgenbauer , Barbara Eichhorst , Michael J. Hallek

Organizations

Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany, Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Colgne, Germany, 2nd Department of Internal Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany, Clinic III, Hematology, Oncology and Palliative Medicine, University of Rostock, Rostock, Germany, Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany, Department of Internal Medicine III, University of Ulm, Ulm, Germany, Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, CECAD Cluster of Excellence at the University of Cologne, Clinical Research Unit (KFO) 286, German CLL Study Group, University of Cologne, Cologne, Germany

Research Funding

Pharmaceutical/Biotech Company

Background: The German CLL study group (GCLLSG) performed three similar phase-II-trials combining a CD20-antibody, ofatumumab (O) or obinutuzumab (G, for GA-101), with ibrutinib (I) or venetoclax (A) in an all-comer population of treatment-naïve or relapsed/refractory CLL patients (pts). Methods: In all 3 trials, pts with high tumor burden received optional bendamustine debulking (BD). Subsequent induction therapy consisted of 6 cycles of I plus O (BIO trial), or I plus G (BIG) or A plus G (BAG). Induction therapy was followed by a maintenance phase using the same drugs until achieving a minimal residual disease (MRD) negative complete remission or up to 24 months. The primary endpoint was the overall response rate (ORR) at the end of induction; secondary endpoints were MRD and safety. Results: 66 pts each were enrolled in the 3 trials. Pts with < 2 induction cycles were excluded from the analysis as per protocol, resulting in 65, 61 and 63 evaluable pts in BIO, BIG and BAG, respectively. The primary endpoint was met in all trials. BD achieved an ORR of 61 % across all trials. During combination therapy one fatal adverse event occurred in each trial; during induction 46 SAEs occurred in BIO, 29 in BIG and 59 in BAG. Patients? characteristics and major results are shown in the Table. Conclusions: The sequential combination concept shows very good efficacy and tolerability. BD reduced the number of IRR. Combination therapies with G seemed more efficient when compared to O. Additionally, combining A plus G seemed to evoke deeper responses than I plus G. Clinical trial information: NCT02689141, NCT02401503 and NCT02345863

BIOBIGBAG
Patients (N)656163
Median age (years)616659
Prior therapies (median)1.51.02.0
TP53 mutations or del(17p)21 (32%)13 (21%)17 (28%)
CLL-IPI high or very high risk42 (67%)41 (67%)38 (63%)
Response
ORR60 (92%)61 (100%)60 (95%)
Complete remission (CR)005 (8%)
Clinical CR or CR with incomplete recovery of the marrow20 (31%)28 (46%)20 (32%)
MRD negative ( < 10-4) after induction9 (14%)29 (48%)55 (87%)
Infusion related reactions during induction (CTC gr. 1 4)
with BD17 (33%)13 (29%)13 (28%)
without BD8 (57%)10 (59%)7 (37%)
Tumor lysis syndrome during induction (CTC gr. 1 4)
with BD01 (2%)1 (2%)
without BD001 (5%)

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Abstract Details

Meeting

2018 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Hematologic Malignancies—Lymphoma and Chronic Lymphocytic Leukemia

Track

Hematologic Malignancies—Lymphoma and Chronic Lymphocytic Leukemia

Sub Track

Chronic Lymphocytic Leukemia (CLL) and Hairy Cell

Clinical Trial Registration Number

NCT02689141, NCT02401503 and NCT02345863

Citation

J Clin Oncol 36, 2018 (suppl; abstr 7513)

DOI

10.1200/JCO.2018.36.15_suppl.7513

Abstract #

7513

Poster Bd #

150

Abstract Disclosures