THURSDAY, May 11, 2023 (HealthDay News) — For fit patients with chronic lymphocytic leukemia (CLL), venetoclax-obinutuzumab with or without ibrutinib, is superior to chemoimmunotherapy as first-line treatment, according to a study published in the May 11 issue of the New England Journal of Medicine.
Barbara Eichhorst, M.D., from the University of Cologne in Germany, and colleagues randomly assigned fit patients with CLL who did not have TP53 aberrations to receive six cycles of chemoimmunotherapy (fludarabine-cyclophosphamide-rituximab or bendamustine-rituximab) or 12 cycles of venetoclax-rituximab, venetoclax-obinutuzumab, or venetoclax-obinutuzumab-ibrutinib (229, 237, 229, and 231 patients, respectively).
The researchers found that the percentage of patients with undetectable minimal residual disease was significantly higher in the venetoclax-obinutuzumab group and the venetoclax-obinutuzumab-ibrutinib group than in the chemoimmunotherapy group (86.5 and 92.2 percent, respectively, versus 52.0 percent), but it was not higher in the venetoclax-rituximab group (57.0 percent). Three-year progression-free survival was 90.5 and 87.7 percent in the venetoclax-obinutuzumab-ibrutinib and venetoclax-obinutuzumab groups, respectively, compared with 75.5 percent in the chemoimmunotherapy group (hazard ratios for disease progression or death, 0.32 and 0.42, respectively), but it was not significantly higher with venetoclax-rituximab (80.8 percent). Grade 3 and 4 infections occurred more often with chemoimmunotherapy and venetoclax-obinutuzumab-ibrutinib than with venetoclax-rituximab or venetoclax-obinutuzumab (18.5, 21.2, 10.5, and 13.2 percent, respectively).
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“In patients with a low burden of coexisting conditions, time-limited venetoclax-obinutuzumab with or without ibrutinib was superior to chemoimmunotherapy with respect to inducing undetectable minimal residual disease and longer progression-free survival,” the authors write.
The study was supported by grants from AbbVie, Janssen, and Roche, which provided some of the study medications.
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