Five years after completing venetoclax – obinutuzumab to treat chronic lymphocytic leukemia (CLL), over half of the treatment-naive patients remained in remission, and over 60% did not require second-line treatment, including many high-risk patients.
Atezolizumab, obinutuzumab, and venetoclax combination therapy is active in patients with untreated DLBCL-Richter’s Syndrome (RS).
In the setting of the COVID-19 pandemic, progression-free survival with first-line ibrutinib + venetoclax + obinutuzumab treatment was not superior to ibrutinib + obinutuzumab for older patients with previously untreated CLL. Follow-up remains ongoing, and many patients in the ibrutinib + venetoclax + obinutuzumab arm achieved undetectable measurable residual disease.
Fixed duration combination therapy of obinutuzumab, ibrutinib, and venetoclax with treatment adjustment based on clinical response and results of measurable residual disease testing shows high efficacy and safety for the front-line treatment of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL / SLL) patients with del (17p) or TP53 mutation offering exciting hope for what has been an unmet need for this group of patients with high-risk disease.
Our own Dr. Brian Koffman interviewed Dr. Matthew Davids, Associate Director of the Center for Chronic Lymphocytic Leukemia (CLL) at Dana-Farber Cancer Institute. They discussed the results of a new study looking at whether combining the anti-CD20 monoclonal antibody obinutuzumab with the BTK inhibitor acalabrutinib provided any additional survival benefit.
In this ongoing trial, the triple combination therapy with acalabrutinib, venetoclax, and obinutuzumab is highly active and has thus far produced durable remissions as a frontline treatment in patients with TP53-aberrant chronic lymphocytic leukemia (CLL), which was generally well tolerated with a low 2.9% incidence of atrial fibrillation with none of the more serious abnormal ventricular heart irregularities seen.
The combination of obinutuzumab (Gazyva), acalabrutinib (Calquence), and venetoclax (Venclexta) failed to meet the pre-specified rate of undetectable measurable or minimal residual disease (uMRD) following optimal debulking with bendamustine in patients with relapsed/refractory chronic lymphocytic leukemia (CLL).
In summary, the results of MAJIC will help to inform the selection of time-limited doublet therapy approaches for patients with CLL / SLL and help define the duration of venetoclax in combination with either acalabrutinib or obinutuzumab.
