Medically reviewed by Dr. Brian Koffman
The Bottom Line:
Patients with relapsed / refractory CLL / SLL treated with zanubrutinib had longer remissions than patients treated with ibrutinib. Zanubrutinib was also safer than ibrutinib.
Who Performed the Research and Where Was it Presented:
Dr. Jennifer Brown from Dana Farber Cancer Institute and colleagues presented the results at the American Society for Hematology (ASH) Annual Meeting 2023.
Background:
The initial results from the ALPINE study showed that zanubrutinib produced longer progression-free survival than ibrutinib in patients with relapsed / refractory chronic lymphocytic leukemia (CLL) / small lymphocytic lymphoma (SLL). It was also better tolerated, and there were fewer cardiac side effects. When this data was presented last year, the median follow-up time was about two years. We have updated data with a median follow-up of about three years.
Methods and Participants:
The ALPINE study is a phase 3 clinical trial where patients with relapsed / refractory CLL / SLL who had received ≥1 prior therapy and had measurable disease were randomly assigned to receive either zanubrutinib or ibrutinib.
Results:
- In total, 327 patients received zanubrutinib, and 325 patients received ibrutinib.
- Zanubrutinib continues to be more effective than ibrutinib.
- At three years, progression-free survival rates were higher with zanubrutinib (66%) than with ibrutinib (54%).
- These benefits were seen across all subgroups of patients, including patients with del(17p) or TP53 mutations, where the progression-free survival rate was 60% with zanubrutinib and 44% with ibrutinib.
- Fewer patients in the zanubrutinib group discontinued treatment due to disease progression and side effects.
- There were fewer serious adverse events in the zanubrutinib group (50%) compared with the ibrutinib group (57%).
- There were fewer cardiac adverse events in the zanubrutinib group compared with the ibrutinib group.
- Atrial fibrillation (abnormal heart rhythm) occurred in 6% of patients taking zanubrutinib and 16% of patients taking ibrutinib.
- Zanubrutinib was associated with significantly fewer hospitalizations than ibrutinib (45% vs. 56%).
Conclusions:
These results confirm that zanubrutinib continues to be more effective and safer than ibrutinib. Patients with relapsed/refractory CLL / SLL treated with zanubrutinib had longer remissions than patients treated with ibrutinib. They also experienced fewer adverse events and hospitalizations. Based on the results from this clinical trial and others, zanubrutinib and acalabrutinib appear to be better choices than ibrutinib for treating CLL / SLL.
Links and Resources:
Watch the interview on the abstract here:
You can read the actual ASH abstract here: Extended Follow-up of ALPINE Randomized Phase 3 Study Confirms Sustained Superior Progression-Free Survival of Zanubrutinib Versus Ibrutinib for Treatment of Relapsed/Refractory Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma (R/R CLL / SLL)
Take care of yourself first.
Ann Liu, PhD
