Three years ago, Dr. Jennifer Woyach presented the game-changing results of the large phase III Alliance A041202 collaborative multi-centered trial, designed to see if we should change how we treat chronic lymphocytic leukemia (CLL) in older patients who have never been treated before. The study showed that ibrutinib was a superior frontline treatment compared with the chemoimmunotherapy combination of bendamustine + rituximab for CLL patients 65 and older, a cohort that represents the majority of CLL patients.
At the annual meeting of the American Society of Hematology (ASH) 2021, Dr. Anthony Mato, Director of the CLL program at Memorial Sloan Kettering Cancer Center in New York, interviewed Dr. Jennifer Woyach, a hematologist-oncologist at the James Cancer Center of the Ohio State University in Columbus, OH. They discussed updated results from the Alliance A041202 trial, which now has longer-term follow-up data.
Takeaways:
- Patients in this trial were 65+ years of age with previously untreated CLL, and they were randomly assigned to receive:
- Bendamustine + rituximab (chemoimmunotherapy)
- Ibrutinib
- Ibrutinib + rituximab
- The median follow-up is now 55 months (~4.5 years).
- Compared with chemoimmunotherapy, both ibrutinib regimens continue to provide superior progression-free survival (the length of time that a patient lives with the disease, but it does not get worse).
- There is still no difference between ibrutinib and ibrutinib + rituximab, indicating that rituximab does not provide any additional benefits with regard to progression-free survival.
- At four years of follow-up, approximately 3 out of 4 patients in the ibrutinib groups remain in remission, and 1 out of 2 patients in the bendamustine + rituximab group remain in remission.
- Strikingly, patients with deletion 17p and TP53 mutation, which are considered high-risk genomic features that have been associated with worse outcomes, did not have worse outcomes on ibrutinib treatment. They responded just as well to ibrutinib therapy as patients without these mutations.
Conclusions:
The results from this trial continue to look just as good as they did three years ago. Patients across all subgroups, even those with high-risk genomic features, continue to experience benefits from ibrutinib treatment. These results support the use of ibrutinib as initial therapy in CLL and strengthen the rationale for using ibrutinib for high-risk disease. It is encouraging to see that targeted therapies provide good treatment options for patients with high-risk disease that does not respond well to traditional chemoimmunotherapy.
Please enjoy this interview with Dr. Woyach from the ASH meeting held in December 2021 in Atlanta, GA, and virtually.
You can read the actual abstract here: Long-Term Results of Alliance A041202 Show Continued Advantage of Ibrutinib-Based Regimens Compared with Bendamustine Plus Rituximab (BR) Chemoimmunotherapy
Take care of yourself first.
Ann Liu, PhD
