Hematologic Malignancies—Lymphoma and Chronic Lymphocytic Leukemia
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HEMATOLOGIC MALIGNANCIES—LYMPHOMA AND CHRONIC LYMPHOCYTIC LEUKEMIA 7500 Oral Abstract Session First results of a head-to-head trial of acalabrutinib versus ibrutinib in previously treated chronic lymphocytic leukemia. John C. Byrd, Peter Hillmen, Paolo Ghia, Arnon P. Kater, Asher Alban Akmal Chanan-Khan, Richard R. Furman, Susan M. O’Brien, Mustafa Nuri Yenerel, A�rpa�d Ille�s, Neil E. Kay, Jose Antonio Garcia Marco, Anthony R. Mato, John Francis Seymour, Stephane Lepre^tre, Stephan Stilgenbauer, Tadeusz Robak, Priti Patel, Kara Higgins, Sophia Sohoni, Wojciech Jurczak; The Ohio State University Wexner Medical Center, Columbus, OH; St. James’s University Hospital, Leeds, United Kingdom; Universita� Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy; Amsterdam University Medical Center, Amsterdam, on behalf of Hovon, Amsterdam, Netherlands; Mayo Clinic, Jacksonville, FL; Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY; Chao Family Comprehensive Cancer Center, University of California, Irvine, CA; Liv Hospital Ulus, Besiktas, Turkey; University of Debrecen, Debre- cen, Hungary; Mayo Clinic, Rochester, MN; Hospital Universitario Puerta de Hierro-Majadahonda, Ma- drid, Spain; University of Pennsylvania, Philadelphia, PA; Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Australia; Centre Henri Becquerel and Normandie University UNI- ROUEN, Rouen, France; University of Ulm, Ulm, Germany; Medican University of Lodz, Lodz, Poland; AstraZeneca, South San Francisco, CA; Maria Sklodowska-Curie National Research Institute of Oncolo- gy, Krakow, Poland Background: Increased selectivity of the Bruton tyrosine kinase inhibitor (BTKi) acalabrutinib (Aca) vs ibrutinib (Ib) may improve tolerability. We conducted an open-label, randomized, noninferiority, phase 3 trial to compare Aca vs Ib in patients (pts) with chronic lymphocytic leukemia (CLL). Methods: Previ- ously treated CLL pts with del(17p) or del(11q) by central lab were randomized to receive oral Aca 100 mg BID or Ib 420 mg QD (stratified by del(17p) status, ECOG PS [2 vs #1], and number of prior thera- pies [1–3 vs $4]) until progression or unacceptable toxicity. Primary endpoint was progression-free sur- vival (PFS) as assessed by IRC; secondary endpoints of all grade atrial fibrillation (AF), grade $3 infection, Richter transformation, and overall survival (OS) were assessed in hierarchical order. Results: 533 pts (Aca, n=268; Ib, n=265) were randomized (median age 66 y; median 2 prior therapies; del(17p) 45.2%; del(11q) 64.2%). At a median follow-up of 40.9 mo (range 0.0–59.1), Aca was non- inferior to Ib with a median PFS of 38.4 mo in both arms (HR 1.00; 95% CI 0.79–1.27). Aca was statis- tically superior to Ib in all-grade AF incidence (9.4% vs 16.0%; P=0.023). Among the other secondary endpoints, incidences of grade $3 infection (Aca: 30.8%, Ib: 30.0%) and Richter transformation (Aca: 3.8%, Ib: 4.9%) were comparable between arms. Median OS was not reached in either arm (HR 0.82 [95% CI 0.59–1.15]), with 63 (23.5%) deaths in the Aca arm and 73 (27.5%) in the Ib arm. Among any-grade AEs in $20% of pts in either arm, Aca was associated with a lower incidence of hypertension (9.4%, 23.2%), arthralgia (15.8%, 22.8%), and diarrhea (34.6%, 46.0%) but a higher incidence of headache (34.6%, 20.2%) and cough (28.9%, 21.3%). AEs led to treatment discontinuation in 14.7% of Aca- vs 21.3% of Ib-treated pts. Among any-grade events of clinical interest, cardiac, hyper- tension, and bleeding events were less frequent with Aca (Table). Conclusions: In this first head-to-head trial of BTKis in CLL, Aca demonstrated non-inferior PFS with less cardiotoxicity and fewer discontinua- tions due to AEs vs Ib. Clinical trial information: NCT02477696. Research Sponsor: Acerta Pharma, a member of the AstraZeneca Group. Selected events of clinical interest. Acalabrutinib (n = 266) Ibrutinib (n = 263) Events, n (%) Any grade Grade $3 Any grade Grade $3 Cardiac events 64 (24.1) 23 (8.6) 79 (30.0) 25 (9.5) Atrial fibrillationa 25 (9.4) 13 (4.9) 42 (16.0) 10 (3.8) Ventricular tachyarrhythmias 0 0 1 (0.4) 1 (0.4) Hypertensionb 25 (9.4) 11 (4.1) 61 (23.2) 24 (9.1) Bleeding events 101 (38.0) 10 (3.8) 135 (51.3) 12 (4.6) Major bleeding eventsc 12 (4.5) 10 (3.8) 14 (5.3) 12 (4.6) Infections 208 (78.2) 82 (30.8) 214 (81.4) 79 (30.0) Second primary malignancies excluding non-melanoma skin cancers 24 (9.0) 16 (6.0) 20 (7.6) 14 (5.3) aIncludes atrial fibrillation and atrial flutter bIncludes hypertension, blood pressure increased, and blood pressure systolic increased cAny hemorrhagic event that was serious, grade $3, or a CNS hemorrhage (any grade). © 2021 by American Society of Clinical Oncology. Visit abstracts.asco.org and search by abstract for disclosure information. HEMATOLOGIC MALIGNANCIES—LYMPHOMA AND CHRONIC LYMPHOCYTIC LEUKEMIA 7501 Oral Abstract Session Fixed-duration (FD) first-line treatment (tx) with ibrutinib (I) plus venetoclax (V) for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): Primary analysis of the FD cohort of the phase 2 captivate study. Paolo Ghia, John N. Allan, Tanya Siddiqi, Thomas J. Kipps, Ryan Jacobs, Stephen Opat, Paul M. Barr, Alessandra Tedeschi, Livio Trentin, Rajat Bannerji, Sharon Jackson, Byrone Kuss, Carol Moreno, Edith Szafer-Glusman, Kristin Russell, Cathy Zhou, Joi Suzuki Ninomoto, James P. Dean, William G. Wierda, Constantine Si Lun Tam; Universita� Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy; Weill Cornell Medicine, New York, NY; City of Hope National Medical Center, Duarte, CA; Univer- sity of California San Diego Moores Cancer Center, La Jolla, CA; Levine Cancer Institute, Charlotte, NC; Monash University, Clayton, Australia; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Middlemore Hospital, Auckland, New Zealand; Flinders University and Medical Centre, Bedford Park, SA, Australia; Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA; Pharmacyclics Inc, Sunnyvale, CA; De- partment of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX; Peter Mac- Callum Cancer Centre & St. Vincent’s Hospital and the University of Melbourne, Melbourne, Australia Background: CAPTIVATE (PCYC-1142) is a multicenter phase 2 study of first-line I+V in CLL. We previ- ously reported results from the Minimal Residual Disease (MRD) cohort wherein undetectable MRD (uMRD) was achieved in over two-thirds of patients (pts) with 12 cycles of I+V, and 30-mo PFS rates were $95% irrespective of subsequent randomized treatment (Wierda, ASH 2020). We now present re- sults from the FD cohort, evaluating fixed-duration tx with I+V. Methods: Pts aged #70 y with previously untreated CLL/SLL received 3 cycles of I then 12 cycles of I+V (I 420 mg/d orally; V ramp-up to 400 mg/d orally). Primary endpoint was CR rate, including CR with incomplete recovery (CRi); secondary endpoints were ORR, duration of response, uMRD rate (<10-4 by 8-color flow cytometry), PFS, OS, tu- mor lysis syndrome (TLS) risk reduction, and adverse events (AEs). Results: 159 pts were enrolled (me- dian age 60 y). High-risk features included del(17p)/TP53 mutation, 17%; del(11q), 18%; complex karyotype, 19%; and unmutated IGHV, 56%. 147 (92%) and 149 (94%) pts completed planned tx with I and V, respectively. Median time on study was 27.9 mo (range, 0.8–33.2). With fixed-duration I+V, CR rate was 55% (95% CI 48–63) in the overall population and was consistent across high-risk subgroups. Of the 88 pts who achieved CR, 78 (89%) had durable CR (duration $1 y); 1 died 7 mo af- ter CR, and 9 with <1 y follow-up were not evaluable. ORR was 96%. Best uMRD response was achieved in 77% of pts in peripheral blood (PB) and 60% of pts in bone marrow (BM). 24-mo PFS was 95%; 24-mo OS was 98%. Results were similar in pts without del(17p) (n=136) (Table). In pts with del(17p)/TP53 mutation (n=27), CR rate was 56%, uMRD rate was 81% (PB) and 41% (BM), and 24- mo PFS was 84% (95% CI 63–94). Of 34 pts with high baseline TLS risk based on tumor burden, 32 (94%) shifted to medium or low risk after I lead-in; no TLS occurred. AEs were primarily grade 1/2. Most common grade 3/4 AEs were neutropenia (33%), hypertension (6%), and neutrophil count de- creased (5%). AEs led to discontinuation of I in 4% and V in 2%. Conclusions: First-line I+V is an all- oral, once-daily, chemotherapy-free, fixed-duration regimen that provides deep, durable responses in pts with CLL/SLL, including those with genomic high-risk features. CR, uMRD rates, PFS, and OS ap- pear favorable. The safety profile of I+V was consistent with known AEs for each agent; no new safety signals were identified. Clinical trial information: NCT02910583. Research Sponsor: Pharmacyclics LLC, an AbbVie Company. Pts without del(17p) All pts Efficacy n=136 N=159 CR/CRi, n (%) 76 (56) 88 (55) Durable CR/CRi, n/N (%)* 66/76 (87) 78/88 (89) ORR, n (%) 130 (96) 153 (96) uMRD in PB, n (%) 104 (76) 122 (77) uMRD in BM, n (%) 84 (62) 95 (60) 24-mo PFS rate, % (95% CI) 96 (91-98) 95 (90-97) 24-mo OS rate, % (95% CI) 98 (93-99) 98 (94-99) *Progression-free $12 cycles from first CR.