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Kittai AS, Allan JN, James D, Bridge H, Miranda M, Yong AS, Fam F, Roos J, Shetty V, Skarbnik AP, Davids MS. An indirect comparison of acalabrutinib with and without obinutuzumab versus zanubrutinib in treatment-naive CLL. Blood Adv 2024:bloodadvances.2023012142. [PMID: 38598745 DOI: 10.1182/bloodadvances.2023012142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
The efficacy and safety of acalabrutinib plus obinutuzumab and acalabrutinib monotherapy versus zanubrutinib in patients with treatment-naive chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) without del(17p) were compared using an unanchored matching-adjusted indirect comparison. Individual patient-level data (IPD) from ELEVATE-TN (acalabrutinib plus obinutuzumab, n = 162; acalabrutinib monotherapy, n = 163) were weighted to match published aggregate baseline data from SEQUOIA cohort 1, which excluded patients with del(17p) (zanubrutinib, n = 241), using variables that were prognostic/predictive of investigator-assessed progression-free survival (INV-PFS) in an exploratory Cox regression analysis of ELEVATE-TN. Post-matching, INV-PFS was longer with acalabrutinib plus obinutuzumab (hazard ratio [HR]: 0.41; 95% CI: 0.23-0.74) and comparable with acalabrutinib monotherapy (HR: 0.91; 95% CI: 0.53-1.56) versus zanubrutinib. Acalabrutinib monotherapy had significantly lower odds of any grade hypertension versus zanubrutinib (OR: 0.44, 95% CI: 0.20-0.99), while acalabrutinib plus obinutuzumab had significantly higher odds of neutropenia (odds ratio [OR]: 2.19; 95% CI: 1.33-3.60) and arthralgia (OR: 2.33; 95% CI: 1.37-3.96) versus zanubrutinib. No other significant differences in safety were observed. In summary, compared with zanubrutinib, acalabrutinib plus obinutuzumab had longer INV-PFS with increased odds of neutropenia and arthralgia, whereas acalabrutinib monotherapy had similar INV-PFS with lower odds of any grade hypertension.
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Affiliation(s)
- Adam S Kittai
- The Ohio State University, Columbus, Ohio, United States
| | - John N Allan
- Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York, United States
| | - Dan James
- Polaris Biostatistics Ltd, Edinburgh, United Kingdom
| | | | | | - Alan Sm Yong
- AstraZeneca, Gaithersburg, Maryland, United States
| | - Fady Fam
- AstraZeneca, Cambridge, United Kingdom
| | - Jack Roos
- AstraZeneca, Gaithersburg, Maryland, United States
| | | | | | - Matthew S Davids
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States
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2
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Samples L, Voutsinas JM, Fakhri B, Khajavian S, Spurgeon SE, Stephens DM, Skarbnik AP, Mato AR, Broome C, Gopal AK, Smith SD, Lynch RC, Rainey MA, Kim MS, Barrett-Campbell O, Hemond E, Tsang M, Ermann DA, Malakhov N, Rao D, Shakib-Azar M, Morrigan B, Chauhan A, Plate T, Gooley TA, Ryan K, Lansigan F, Hill BT, Pongas G, Parikh SA, Roeker LE, Allan JN, Cheng R, Ujjani C, Shadman M. Hypertension Treatment in Patients Receiving Ibrutinib: A Multicenter Retrospective Study. Blood Adv 2024:bloodadvances.2023011569. [PMID: 38315043 DOI: 10.1182/bloodadvances.2023011569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 02/07/2024] Open
Abstract
Although Bruton's tyrosine kinase inhibitors (BTKis) are generally well-tolerated and less toxic than chemotherapy alternatives used to treat lymphoid malignancies, BTKis like ibrutinib have the potential to cause new or worsening hypertension (HTN). Little is known about the optimal treatment of BTKi-associated HTN. Randomly selected patients with lymphoid malignancies on a BTKi and anti-hypertensive drug(s) and with at least 3 months of follow up data were sorted into two groups: those diagnosed with HTN prior to BTKi initiation (prior-HTN), and those diagnosed with HTN after BTKi initiation (de novo HTN). Generalized estimating equations assessed associations between time varying mean arterial pressures (MAPs) and individual anti-HTN drug categories. Of the 196 patients included in the study, 118 had prior-HTN, and 78 developed de novo HTN. Statistically significant mean MAP reductions were observed in patients with prior-HTN who took beta blockers (BBs) with hydrochlorothiazide (HCTZ), (-5.05 mmHg; 95% CI -10.0 to -0.0596; p = 0.047), and patients diagnosed with de novo HTN who took either an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) with HCTZ (-5.47 mmHg; 95% CI -10.9 to -0.001; p = 0.05). These regimens also correlated with the greatest percentages of normotensive MAPs. Treatment of HTN in patients taking a BTKi is challenging and may require multiple anti-hypertensives. Patients with prior-HTN appear to benefit from combination regimens with BBs and HCTZ, whereas patients with de novo HTN appear to benefit from ACEi/ARBs with HCTZ. These results should be confirmed in prospective studies.
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Affiliation(s)
- Laura Samples
- University of Washington School of Medicine, United States
| | - Jenna M Voutsinas
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Bita Fakhri
- UCSF Medical Center, San Francisco, California, United States
| | - Sirin Khajavian
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Philadelphia, United States
| | | | - Deborah M Stephens
- University of North Carolina, Chapel Hill, North Carolina, United States
| | | | | | - Catherine Broome
- Division of Hematology, MedStar Georgetown University Hospital, Washington, District of Columbia, United States
| | | | | | | | - Magdalena A Rainey
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States
| | | | | | - Emily Hemond
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Mazie Tsang
- Mayo Clinic, Phoenix, California, United States
| | - Daniel A Ermann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Nikita Malakhov
- Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York, United States
| | - Danielle Rao
- Memorial Sloan Kettering Cancer Center, New York,, New York, United States
| | | | - Beth Morrigan
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Ayushi Chauhan
- Medical College of Georgia, Georgia Cancer Center, Augusta, Georgia, United States
| | - Thomas Plate
- University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ted A Gooley
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Kellie Ryan
- AstraZeneca, Gaithersburg, Maryland, United States
| | | | - Brian T Hill
- Cleveland Clinic, Cleveland, Ohio, United States
| | - Georgios Pongas
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, United States
| | | | | | - John N Allan
- Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York, United States
| | - Richard Cheng
- University of Washington School of Medicine, Seattle, Washington, United States
| | - Chaitra Ujjani
- University of Washington School of Medicine, United States
| | - Mazyar Shadman
- University of Washington School of Medicine, United States
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Jain N, Croner LJ, Allan JN, Siddiqi T, Tedeschi A, Badoux XC, Eckert K, Cheung LW, Mukherjee A, Dean JP, Szafer-Glusman E, Seymour JF. Absence of BTK, BCL2, and PLCG2 Mutations in Chronic Lymphocytic Leukemia Relapsing after First-Line Treatment with Fixed-Duration Ibrutinib plus Venetoclax. Clin Cancer Res 2024; 30:498-505. [PMID: 37955424 PMCID: PMC10831330 DOI: 10.1158/1078-0432.ccr-22-3934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/27/2023] [Accepted: 08/14/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Mutations in BTK, PLCG2, and BCL2 have been reported in patients with progressive disease (PD) on continuous single-agent BTK or BCL2 inhibitor treatment. We tested for these mutations in samples from patients with PD after completion of first-line treatment with fixed-duration ibrutinib plus venetoclax for chronic lymphocytic leukemia (CLL) in the phase II CAPTIVATE study. PATIENTS AND METHODS A total of 191 patients completed fixed-duration ibrutinib plus venetoclax (three cycles of ibrutinib then 12-13 cycles of ibrutinib plus venetoclax). Genomic risk features [del(11q), del(13q), del(17p), trisomy 12, complex karyotype, unmutated IGHV, TP53 mutated] and mutations in genes recurrently mutated in CLL (ATM, BIRC3, BRAF, CHD2, EZH2, FBXW7, MYD88, NOTCH1, POT1, RPS15, SF3B1, XPO1) were assessed at baseline in patients with and without PD at data cutoff; gene variants and resistance-associated mutations in BTK, PLCG2, or BCL2 were evaluated at PD. RESULTS Of 191 patients completing fixed-duration ibrutinib plus venetoclax, with median follow-up of 38.9 months, 29 (15%) developed PD. No baseline risk feature or gene mutation was significantly associated with development of PD. No previously reported resistance-associated mutations in BTK, PLCG2, or BCL2 were detected at PD in 25 patients with available samples. Of the 29 patients with PD, 19 have required retreatment (single-agent ibrutinib, n = 16, or ibrutinib plus venetoclax, n = 3); 17 achieved partial response or better, 1 achieved stable disease, and 1 is pending response assessment. CONCLUSIONS First-line fixed-duration combination treatment with ibrutinib plus venetoclax may mitigate development of resistance mechanisms associated with continuous single-agent targeted therapies, allowing for effective retreatment. See related commentary by Al-Sawaf and Davids, p. 471.
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Affiliation(s)
- Nitin Jain
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lisa J. Croner
- AbbVie, North Chicago, Illinois
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | | | - Tanya Siddiqi
- City of Hope National Medical Center, Duarte, California
| | | | | | - Karl Eckert
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Leo W.K. Cheung
- AbbVie, North Chicago, Illinois
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Anwesha Mukherjee
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - James P. Dean
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Edith Szafer-Glusman
- AbbVie, North Chicago, Illinois
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - John F. Seymour
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, and University of Melbourne, Melbourne, Victoria, Australia
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Marullo R, Rutherford SC, Revuelta MV, Zamponi N, Culjkovic-Kraljacic B, Kotlov N, Di Siervi N, Lara-Garcia J, Allan JN, Ruan J, Furman RR, Chen Z, Shore TB, Phillips AA, Mayer S, Hsu J, van Besien K, Leonard JP, Borden KL, Inghirami G, Martin P, Cerchietti L. XPO1 Enables Adaptive Regulation of mRNA Export Required for Genotoxic Stress Tolerance in Cancer Cells. Cancer Res 2024; 84:101-117. [PMID: 37801604 PMCID: PMC10758694 DOI: 10.1158/0008-5472.can-23-1992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
Exportin-1 (XPO1), the main soluble nuclear export receptor in eukaryotic cells, is frequently overexpressed in diffuse large B-cell lymphoma (DLBCL). A selective XPO1 inhibitor, selinexor, received approval as single agent for relapsed or refractory (R/R) DLBCL. Elucidating the mechanisms by which XPO1 overexpression supports cancer cells could facilitate further clinical development of XPO1 inhibitors. We uncovered here that XPO1 overexpression increases tolerance to genotoxic stress, leading to a poor response to chemoimmunotherapy. Upon DNA damage induced by MYC expression or exogenous compounds, XPO1 bound and exported EIF4E and THOC4 carrying DNA damage repair mRNAs, thereby increasing synthesis of DNA damage repair proteins under conditions of increased turnover. Consequently, XPO1 inhibition decreased the capacity of lymphoma cells to repair DNA damage and ultimately resulted in increased cytotoxicity. In a phase I clinical trial conducted in R/R DLBCL, the combination of selinexor with second-line chemoimmunotherapy was tolerated with early indication of efficacy. Overall, this study reveals that XPO1 overexpression plays a critical role in the increased tolerance of cancer cells to DNA damage while providing new insights to optimize the clinical development of XPO1 inhibitors. SIGNIFICANCE XPO1 regulates the dynamic ribonucleoprotein nuclear export in response to genotoxic stress to support tolerance and can be targeted to enhance the sensitivity of cancer cells to endogenous and exogenous DNA damage. See related commentary by Knittel and Reinhardt, p. 3.
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Affiliation(s)
- Rossella Marullo
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Sarah C. Rutherford
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Maria V. Revuelta
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Nahuel Zamponi
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Biljana Culjkovic-Kraljacic
- Institute for Research in Immunology and Cancer and Department of Pathology and Cell Biology, University of Montreal, Montreal, Canada
| | | | - Nicolás Di Siervi
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Juan Lara-Garcia
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - John N. Allan
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Jia Ruan
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Richard R. Furman
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Zhengming Chen
- Division of Biostatistics, Population Health Sciences Department, Weill Cornell Medicine, New York, New York
| | - Tsiporah B. Shore
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Adrienne A. Phillips
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Sebastian Mayer
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Jingmei Hsu
- New York University Grossman School of Medicine, New York, New York
| | | | - John P. Leonard
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Katherine L.B. Borden
- Institute for Research in Immunology and Cancer and Department of Pathology and Cell Biology, University of Montreal, Montreal, Canada
| | - Giorgio Inghirami
- Pathology and Laboratory Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Peter Martin
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Leandro Cerchietti
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
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Chong SJF, Zhu F, Dashevsky O, Mizuno R, Lai JX, Hackett L, Ryan CE, Collins MC, Iorgulescu JB, Guièze R, Penailillo J, Carrasco R, Hwang YC, Muñoz DP, Bouhaddou M, Lim YC, Wu CJ, Allan JN, Furman RR, Goh BC, Pervaiz S, Coppé JP, Mitsiades CS, Davids MS. Hyperphosphorylation of BCL-2 family proteins underlies functional resistance to venetoclax in lymphoid malignancies. J Clin Invest 2023; 133:e170169. [PMID: 37751299 PMCID: PMC10645378 DOI: 10.1172/jci170169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023] Open
Abstract
The B cell leukemia/lymphoma 2 (BCL-2) inhibitor venetoclax is effective in chronic lymphocytic leukemia (CLL); however, resistance may develop over time. Other lymphoid malignancies such as diffuse large B cell lymphoma (DLBCL) are frequently intrinsically resistant to venetoclax. Although genomic resistance mechanisms such as BCL2 mutations have been described, this probably only explains a subset of resistant cases. Using 2 complementary functional precision medicine techniques - BH3 profiling and high-throughput kinase activity mapping - we found that hyperphosphorylation of BCL-2 family proteins, including antiapoptotic myeloid leukemia 1 (MCL-1) and BCL-2 and proapoptotic BCL-2 agonist of cell death (BAD) and BCL-2 associated X, apoptosis regulator (BAX), underlies functional mechanisms of both intrinsic and acquired resistance to venetoclax in CLL and DLBCL. Additionally, we provide evidence that antiapoptotic BCL-2 family protein phosphorylation altered the apoptotic protein interactome, thereby changing the profile of functional dependence on these prosurvival proteins. Targeting BCL-2 family protein phosphorylation with phosphatase-activating drugs rewired these dependencies, thus restoring sensitivity to venetoclax in a panel of venetoclax-resistant lymphoid cell lines, a resistant mouse model, and in paired patient samples before venetoclax treatment and at the time of progression.
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MESH Headings
- Mice
- Animals
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Drug Resistance, Neoplasm/genetics
- Proto-Oncogene Proteins c-bcl-2/genetics
- Bridged Bicyclo Compounds, Heterocyclic/pharmacology
- bcl-X Protein/genetics
- Apoptosis Regulatory Proteins
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Cell Line, Tumor
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Apoptosis/genetics
- Myeloid Cell Leukemia Sequence 1 Protein/genetics
- Myeloid Cell Leukemia Sequence 1 Protein/metabolism
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Affiliation(s)
- Stephen Jun Fei Chong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Fen Zhu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Olga Dashevsky
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rin Mizuno
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Jolin X.H. Lai
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Liam Hackett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine E. Ryan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary C. Collins
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - J. Bryan Iorgulescu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Romain Guièze
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Johany Penailillo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ruben Carrasco
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Yeonjoo C. Hwang
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, California, USA
| | - Denise P. Muñoz
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, California, USA
| | - Mehdi Bouhaddou
- Department of Microbiology, Immunology and Molecular Genetics, UCLA, Los Angeles, California, USA
| | - Yaw Chyn Lim
- Cancer Science Institute, National University of Singapore, Singapore
| | - Catherine J. Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - John N. Allan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Richard R. Furman
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Boon Cher Goh
- Cancer Science Institute, National University of Singapore, Singapore
| | - Shazib Pervaiz
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jean-Philippe Coppé
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, California, USA
| | - Constantine S. Mitsiades
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew S. Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Allan JN, Flinn IW, Siddiqi T, Ghia P, Tam CS, Kipps TJ, Barr PM, Elinder Camburn A, Tedeschi A, Badoux XC, Jacobs R, Kuss BJ, Trentin L, Zhou C, Szoke A, Abbazio C, Wierda WG. Outcomes in Patients with High-Risk Features after Fixed-Duration Ibrutinib plus Venetoclax: Phase II CAPTIVATE Study in First-Line Chronic Lymphocytic Leukemia. Clin Cancer Res 2023; 29:2593-2601. [PMID: 37282671 PMCID: PMC10345960 DOI: 10.1158/1078-0432.ccr-22-2779] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/20/2022] [Accepted: 03/10/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The CAPTIVATE study investigated first-line ibrutinib plus venetoclax for chronic lymphocytic leukemia in 2 cohorts: minimal residual disease (MRD)-guided randomized discontinuation (MRD cohort) and Fixed Duration (FD cohort). We report outcomes of fixed-duration ibrutinib plus venetoclax in patients with high-risk genomic features [del(17p), TP53 mutation, and/or unmutated immunoglobulin heavy chain (IGHV)] in CAPTIVATE. PATIENTS AND METHODS Patients received three cycles of ibrutinib 420 mg/day then 12 cycles of ibrutinib plus venetoclax (5-week ramp-up to 400 mg/day). FD cohort patients (n = 159) received no further treatment. Forty-three MRD cohort patients with confirmed undetectable MRD (uMRD) after 12 cycles of ibrutinib plus venetoclax received randomized placebo treatment. RESULTS Of 195 patients with known status of genomic risk features at baseline, 129 (66%) had ≥1 high-risk feature. Overall response rates were >95% regardless of high-risk features. In patients with and without high-risk features, respectively, complete response (CR) rates were 61% and 53%; best uMRD rates: 88% and 70% (peripheral blood) and 72% and 61% (bone marrow); 36-month progression-free survival (PFS) rates: 88% and 92%. In subsets with del(17p)/TP53 mutation (n = 29) and unmutated IGHV without del(17p)/TP53 mutation (n = 100), respectively, CR rates were 52% and 64%; uMRD rates: 83% and 90% (peripheral blood) and 45% and 80% (bone marrow); 36-month PFS rates: 81% and 90%. Thirty-six-month overall survival (OS) rates were >95% regardless of high-risk features. CONCLUSIONS Deep, durable responses and sustained PFS seen with fixed-duration ibrutinib plus venetoclax are maintained in patients with high-risk genomic features, with similar PFS and OS to those without high-risk features. See related commentary by Rogers, p. 2561.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Piperidines/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
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Affiliation(s)
| | - Ian W. Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
| | - Tanya Siddiqi
- City of Hope National Medical Center, Duarte, California
| | - Paolo Ghia
- Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Constantine S. Tam
- Peter MacCallum Cancer Center and St. Vincent's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
| | | | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | | | | | | | - Ryan Jacobs
- Levine Cancer Institute, Charlotte, North Carolina
| | - Bryone J. Kuss
- Flinders University and Medical Centre, Bedford Park, South Australia, Australia
| | | | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Anita Szoke
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | | | - William G. Wierda
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas
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7
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SahBandar IN, Sy CB, van den Akker T, Kim D, Geyer JT, Chadburn A, Cesarman E, Inghirami G, Allan JN, Siddiqui MT, Ouseph MM. Primary Effusion Lymphoma in an HIV-Negative Patient with Chronic Myeloid Leukemia Treated with Dasatinib. Pathobiology 2023; 90:356-364. [PMID: 36996787 PMCID: PMC10614567 DOI: 10.1159/000530429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/28/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Primary effusion lymphoma (PEL) is a malignant lymphomatous effusion, which by definition is Kaposi sarcoma herpesvirus/human herpesvirus 8-positive. PEL typically occurs in HIV-infected patients but can also occur in HIV-negative individuals, including in organ transplant recipients. Tyrosine kinase inhibitors (TKIs) are currently the standard of care for patients with chronic myeloid leukemia (CML), BCR::ABL1-positive. Although TKIs are extremely effective in treating CML, they alter T-cell function by inhibiting peripheral T-cell migration and altering T-cell trafficking and have been associated with the development of pleural effusions. CASE PRESENTATION We report a case of PEL in a young, relatively immunocompetent patient with no history of organ transplant receiving dasatinib for CML, BCR::ABL1-positive. DISCUSSION We hypothesize that the loss of T-cell function secondary to TKI therapy (dasatinib) may have resulted in the unchecked cellular proliferation of Kaposi sarcoma herpesvirus (KSHV)-infected cells, leading to the emergence of a PEL. We recommend cytologic investigation and KSHV testing in patients being treated with dasatinib for CML who present with persistent or recurrent effusions.
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MESH Headings
- Humans
- Dasatinib/adverse effects
- Lymphoma, Primary Effusion/diagnosis
- Lymphoma, Primary Effusion/drug therapy
- Lymphoma, Primary Effusion/chemically induced
- Sarcoma, Kaposi/chemically induced
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/chemically induced
- Herpesvirus 8, Human
- HIV Infections/complications
- HIV Infections/drug therapy
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Affiliation(s)
- Ivo N SahBandar
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA,
| | - Chandler B Sy
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Tayler van den Akker
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David Kim
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Julia T Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - John N Allan
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Madhu M Ouseph
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
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8
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Shadman M, Manzoor BS, Sail K, Tuncer HH, Allan JN, Ujjani C, Emechebe N, Kamalakar R, Coombs CC, Leslie L, Barr PM, Brown JR, Eyre TA, Rampotas A, Schuh A, Lamanna N, Skarbnik A, Roeker LE, Bannerji R, Eichhorst B, Fleury I, Davids MS, Alhasani H, Jiang D, Hill BT, Schuster SJ, Brander DM, Pivneva I, Burne R, Guerin A, Mato AR. Treatment Discontinuation Patterns for Patients With Chronic Lymphocytic Leukemia in Real-World Settings: Results From a Multi-Center International Study. Clin Lymphoma Myeloma Leuk 2023:S2152-2650(23)00107-6. [PMID: 37076367 DOI: 10.1016/j.clml.2023.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This study assessed treatment discontinuation patterns and reasons among chronic lymphocytic leukemia (CLL) patients initiating first-line (1L) and second-line (2L) treatments in real-world settings. MATERIALS AND METHODS Using deidentified electronic medical records from the CLL Collaborative Study of Real-World Evidence, premature treatment discontinuation was assessed among FCR, BR, BTKi-based, and BCL-2-based regimen cohorts. RESULTS Of 1364 1L patients (initiated in 1997-2021), 190/13.9% received FCR (23.7% discontinued prematurely); 255/18.7% received BR (34.5% discontinued prematurely); 473/34.7% received BTKi-based regimens, of whom 28.1% discontinued prematurely; and 43/3.2% received venetoclax-based regimens, of whom 16.3% discontinued prematurely (venetoclax monotherapy: 7/0.5%, of whom 42.9% discontinued; VG/VR: 36/2.6%, of whom 11.1% discontinued). The most common reasons for treatment discontinuation were adverse events (FCR: 25/13.2%; BR: 36/14.1%; BTKi-based regimens: 75/15.9%) and disease progression (venetoclax-based: 3/7.0%). Of 626 2L patients, 20/3.2% received FCR (50.0% discontinued); 62/9.9% received BR (35.5% discontinued); 303/48.4% received BTKi-based regimens, of whom 38.0% discontinued; and 73/11.7% received venetoclax-based regimens, of whom 30.1% discontinued (venetoclax monotherapy: 27/4.3%, of whom 29.6% discontinued; VG/VR: 43/6.9%, of whom 27.9% discontinued). The most common reasons for treatment discontinuation were adverse events (FCR: 6/30.0%; BR: 11/17.7%; BTKi-based regimens: 60/19.8%; venetoclax-based: 6/8.2%). CONCLUSION The findings of this study highlight the continued need for tolerable therapies in CLL, with finite therapy offering a better tolerated option for patients who are newly diagnosed or relapsed/refractory to prior treatments.
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Affiliation(s)
- Mazyar Shadman
- Fred Hutch Cancer Center and University of Washington, Seattle, WA
| | | | | | - Hande H Tuncer
- The Cancer Center at Lowell General Hospital, Lowell, MA
| | | | - Chaitra Ujjani
- Fred Hutch Cancer Center and University of Washington, Seattle, WA
| | | | | | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lori Leslie
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Toby A Eyre
- Churchill Hospital, Oxford University, Oxford, UK
| | | | - Anna Schuh
- Churchill Hospital, Oxford University, Oxford, UK
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | | | - Lindsey E Roeker
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Barbara Eichhorst
- Department of Internal Medicine, Center of Integrated Oncology Köln Bonn, University of Cologne, Cologne, Germany
| | | | | | | | | | | | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Anthony R Mato
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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9
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Mejia Saldarriaga M, Alhomoud M, Roboz G, Allan JN, Ruan J, Ouseph MM, Simonson PD, Bustoros M, Niesvizky R. Angioimmunoblastic T-cell lymphoma presenting with severe plasmacytosis mimicking plasma cell leukemia. Am J Hematol 2023. [PMID: 36785525 DOI: 10.1002/ajh.26878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
Peripheral blood smear (A) demonstrates increased numbers of plasma cells (representative cells indicated by arrows), (B) demonstrates polytypic nature of plasma cells.
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Affiliation(s)
| | - Mohammad Alhomoud
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Gail Roboz
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - John N Allan
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Jia Ruan
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Madhu M Ouseph
- Division of Pathology & Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Paul D Simonson
- Division of Pathology & Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Mark Bustoros
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Ruben Niesvizky
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
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10
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Arruga F, Rubin M, Papazoglou D, Iannello A, Ioannou N, Moia R, Rossi D, Gaidano G, Coscia M, Laurenti L, D'Arena G, Allan JN, Furman RR, Vaisitti T, Ramsay AG, Deaglio S. The immunomodulatory molecule TIGIT is expressed by chronic lymphocytic leukemia cells and contributes to anergy. Haematologica 2023. [PMID: 36655432 PMCID: PMC10388274 DOI: 10.3324/haematol.2022.282177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Indexed: 01/20/2023] Open
Abstract
T-cell immunoreceptor with Ig and ITIM domains (TIGIT) is an inhibitory checkpoint receptor that negatively regulates T cell responses. CD226 competes with TIGIT for binding to the CD155 ligand, delivering a positive signal to the T cell. Here we studied expression of TIGIT and CD226 in a cohort of 115 chronic lymphocytic leukemia (CLL) patients and report expression of TIGIT and CD226 by leukemic cells. By devising a TIGIT/CD226 ratio, we showed that CLL cells favoring TIGIT over CD226 are typical of a more indolent disease, while those favoring CD226 are characterized by a shorter time-to-first-treatment and shorter progression-fee survival after first treatment. TIGIT expression was inversely correlated to the B cell receptor (BCR) signaling capacity, as determined by studying BTK phosphorylation, cell proliferation and IL-10 production. In CLL cells treated with ibrutinib, where surface IgM and BCR signaling capacity are temporarily increased, TIGIT expression was downmodulated, in line with data indicating transient recovery from anergy. Lastly, cells from Richter syndrome patients were characterized by high levels of CD226, with low to undetectable TIGIT, in keeping with their high proliferative drive. Together, these data suggest that TIGIT contributes to CLL anergy by downregulating BCR signaling, identifying novel and actionable molecular circuits regulating anergy and modulating CLL cell functions.
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Affiliation(s)
- Francesca Arruga
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin
| | - Marta Rubin
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin
| | | | - Andrea Iannello
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin
| | - Nikolaos Ioannou
- School of Cancer and Pharmaceutical Sciences, King's College London, London
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara
| | - Davide Rossi
- Laboratory of Experimental Hematology, Institute of Oncology Research; Faculty of Biomedical Sciences, Universita della Svizzera Italiana
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Turin and Division of Hematology, A.O.U. Citta della Salute e della Scienza di Torino, Turin
| | - Luca Laurenti
- Hematology Unit, IRCCS Fondazione Policlinico Gemelli, Catholic University of "Sacred Heart", Rome
| | | | - John N Allan
- Department of Hematology, Weill Cornell Medicine, New York, NY
| | | | - Tiziana Vaisitti
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin
| | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, King's College London, London
| | - Silvia Deaglio
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin.
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11
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Barr PM, Tedeschi A, Wierda WG, Allan JN, Ghia P, Vallisa D, Jacobs R, O'Brien S, Grigg AP, Walker P, Zhou C, Ninomoto J, Krigsfeld G, Tam CS. Effective Tumor Debulking with Ibrutinib Before Initiation of Venetoclax: Results from the CAPTIVATE Minimal Residual Disease and Fixed-Duration Cohorts. Clin Cancer Res 2022; 28:4385-4391. [PMID: 35939599 PMCID: PMC9561555 DOI: 10.1158/1078-0432.ccr-22-0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/19/2022] [Accepted: 08/03/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The phase II CAPTIVATE study investigated first-line treatment with ibrutinib plus venetoclax for chronic lymphocytic leukemia in two cohorts: minimal residual disease (MRD)-guided randomized treatment discontinuation (MRD cohort) and fixed duration (FD cohort). We report tumor debulking and tumor lysis syndrome (TLS) risk category reduction with three cycles of single-agent ibrutinib lead-in before initiation of venetoclax using pooled data from the MRD and FD cohorts. PATIENTS AND METHODS In both cohorts, patients initially received three cycles of ibrutinib 420 mg/day then 12 cycles of ibrutinib plus venetoclax (5-week ramp-up to 400 mg/day). RESULTS In the total population (N = 323), the following decreases from baseline to after ibrutinib lead-in were observed: percentage of patients with a lymph node diameter ≥5 cm decreased from 31% to 4%, with absolute lymphocyte count ≥25 × 109/L from 76% to 65%, with high tumor burden category for TLS risk from 23% to 2%, and with an indication for hospitalization (high TLS risk, or medium TLS risk and creatinine clearance <80 mL/minute) from 43% to 18%. Laboratory TLS per Howard criteria occurred in one patient; no clinical TLS was observed. CONCLUSIONS Three cycles of ibrutinib lead-in before venetoclax initiation provides effective tumor debulking, decreases the TLS risk category and reduces the need for hospitalization for intensive monitoring for TLS.
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Affiliation(s)
- Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.,Corresponding Author: Paul M. Barr, Wilmot Cancer Institute, 601 Elmwood Avenue #704, Rochester, NY 14642. Phone: 216-338-6299; Fax: 585-273-5761; E-mail:
| | | | - William G. Wierda
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Paolo Ghia
- Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Ryan Jacobs
- Levine Cancer Institute, Charlotte, North Carolina
| | - Susan O'Brien
- UC Irvine, Chao Family Comprehensive Cancer Center, Irvine, California
| | | | - Patricia Walker
- Peninsula Health and Peninsula Private Hospital, Frankston, Victoria, Australia
| | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Joi Ninomoto
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Gabriel Krigsfeld
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Constantine S. Tam
- Peter MacCallum Cancer Center & St. Vincent's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
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12
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Allan JN. The clinical importance of prognostic markers in CLL. Clin Adv Hematol Oncol 2022; 20:606-608. [PMID: 36206072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- John N Allan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
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13
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Allan JN. The future role of bispecific antibodies in lymphoma. Clin Adv Hematol Oncol 2022; 20:500-502. [PMID: 36125955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- John N Allan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
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14
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Allan JN, Flinn IW, Siddiqi T, Ghia P, Tam CS, Kipps TJ, Barr PM, Camburn AE, Tedeschi A, Badoux XC, Jacobs R, Kuss BJ, Trentin L, Zhou C, Szoke A, Naganuma M, Wierda WG. Abstract CT028: Fixed-duration (FD) ibrutinib (Ibr) + venetoclax (Ven) for first-line treatment of chronic lymphocytic leukemia (CLL) in patients (pts) with high-risk features: phase 2 CAPTIVATE study. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: CAPTIVATE (PCYC-1142; NCT02910583) is an international, multicenter phase 2 study of first-line Ibr + Ven in CLL with 2 cohorts: the Minimal Residual Disease (MRD) and FD cohorts. FD Ibr + Ven provides deep, durable responses (Ghia, ASCO 2021; Wierda, J Clin Oncol 2021). Here, we report efficacy and safety of FD Ibr + Ven in pts with high-risk features.
Methods: Pts aged ≤70 y with previously untreated CLL received 3 cycles of Ibr then 12 cycles of Ibr + Ven (Ibr 420 mg/d orally; Ven ramp-up to 400 mg/d orally). Pts in the FD cohort received no further treatment. Pts in the MRD cohort were randomized to subsequent treatment according to MRD status, including a placebo arm for pts who achieved confirmed undetectable MRD (uMRD) with 12 cycles of Ibr + Ven. Data from the FD cohort and MRD cohort placebo arm were pooled for pts with high-risk features (del(17p), TP53 mutated, or unmutated IGHV) treated with FD Ibr + Ven.
Results: Of 202 pts treated with FD Ibr + Ven in the FD cohort (n=159) or MRD cohort placebo arm (n=43), 129 pts had high-risk features (Table). Median time on study for these pts was 28.7 mo (range 0.8-45.1). 94% of pts completed planned treatment with Ibr and Ven. Median treatment duration was 13.8 mo (range 0.7-24.9) for Ibr and 11.1 mo (range 9.9-22.1) for Ven. Best response rates of CR and uMRD in peripheral blood and bone marrow were high (Table). The 18-mo landmark estimate for duration of CR was 95%. 24-mo PFS rate was 94%, which was similar to pts without high-risk features (97%). Only 3% of pts discontinued Ibr or Ven due to AEs. The AE profile of Ibr + Ven in pts with high-risk features showed no new safety findings for this FD regimen (Table).
Conclusion: First-line Ibr + Ven for a fixed duration provides durable treatment-free remissions and sustained PFS in pts with CLL. These clinical outcomes are maintained in pts with high-risk features, with PFS rates that were similar to pts without high-risk features.
Table. Baseline characteristics, efficacy outcomes, and safety Pts with high-risk features (n=129) BASELINE CHARACTERISTICS Median age, y (range) 60 (33-70) Rai stage III/IV, n (%) 36 (28) Bulky disease ≥5 cm, n (%) 47 (36) Genomic risk features, n (%) del(17p) and/or TP53 mutated 29 (22) Unmutated IGHV 119 (92) Complex karyotypea 27 (21) EFFICACY OUTCOMES Overall response rate, n (%) 126 (98) CR, n (%) 76 (59) 18-mo DOCR, % (95% CI) 95 (85-98) uMRD <10-4 by flow, n (%) Peripheral blood 114 (88) Bone marrow 93 (72) 24-mo PFS rate, % (95% CI) 94 (88-97) 24-mo OS rate, % (95% CI) 98 (93-99) SAFETY OUTCOMES Grade 3/4 AEs in ≥5% of pts, n (%) Neutropenia 38 (29) Hypertension 12 (9) Neutrophil count decreased 9 (7) aDefined as ≥3 abnormalities by CpG-stimulated cytogenetics.
Citation Format: John N. Allan, Ian W. Flinn, Tanya Siddiqi, Paolo Ghia, Constantine S. Tam, Thomas J. Kipps, Paul M. Barr, Anna Elinder Camburn, Alessandra Tedeschi, Xavier C. Badoux, Ryan Jacobs, Bryone J. Kuss, Livio Trentin, Cathy Zhou, Anita Szoke, Maoko Naganuma, William G. Wierda. Fixed-duration (FD) ibrutinib (Ibr) + venetoclax (Ven) for first-line treatment of chronic lymphocytic leukemia (CLL) in patients (pts) with high-risk features: phase 2 CAPTIVATE study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT028.
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Affiliation(s)
| | - Ian W. Flinn
- 2Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | | | - Paolo Ghia
- 4Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Constantine S. Tam
- 5Peter MacCallum Cancer Center & St. Vincent's Hospital and the University of Melbourne, Melbourne, Australia
| | | | - Paul M. Barr
- 7Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Bryone J. Kuss
- 12Flinders University and Medical Centre, Bedford Park, Australia
| | | | - Cathy Zhou
- 14Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - Anita Szoke
- 14Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - Maoko Naganuma
- 14Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - William G. Wierda
- 15Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
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15
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Tam CS, Allan JN, Siddiqi T, Kipps TJ, Jacobs R, Opat S, Barr PM, Tedeschi A, Trentin L, Bannerji R, Jackson S, Kuss BJ, Moreno C, Szafer-Glusman E, Russell K, Zhou C, Ninomoto J, Dean JP, Wierda WG, Ghia P. Fixed-duration ibrutinib plus venetoclax for first-line treatment of CLL: primary analysis of the CAPTIVATE FD cohort. Blood 2022; 139:3278-3289. [PMID: 35196370 PMCID: PMC11022982 DOI: 10.1182/blood.2021014488] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
CAPTIVATE (NCT02910583) is an international phase 2 study in patients aged ≤70 years with previously untreated chronic lymphocytic leukemia (CLL). Results from the cohort investigating fixed-duration (FD) treatment with ibrutinib plus venetoclax are reported. Patients received 3 cycles of ibrutinib lead-in then 12 cycles of ibrutinib plus venetoclax (oral ibrutinib [420 mg/d]; oral venetoclax [5-week ramp-up to 400 mg/d]). The primary endpoint was complete response (CR) rate. Hypothesis testing was performed for patients without del(17p) with prespecified analyses in all treated patients. Secondary endpoints included undetectable minimal residual disease (uMRD) rates, progression-free survival (PFS), overall survival (OS), and safety. Of the 159 patients enrolled and treated, 136 were without del(17p). The median time on study was 27.9 months, and 92% of patients completed all planned treatment. The primary endpoint was met, with a CR rate of 56% (95% confidence interval [CI], 48-64) in patients without del(17p), significantly higher than the prespecified 37% minimum rate (P < .0001). In the all-treated population, CR rate was 55% (95% CI, 48-63); best uMRD rates were 77% (peripheral blood [PB]) and 60% (bone marrow [BM]); 24-month PFS and OS rates were 95% and 98%, respectively. At baseline, 21% of patients were in the high tumor burden category for tumor lysis syndrome (TLS) risk; after ibrutinib lead-in, only 1% remained in this category. The most common grade ≥3 adverse events (AEs) were neutropenia (33%) and hypertension (6%). First-line ibrutinib plus venetoclax represents the first all-oral, once-daily, chemotherapy-free FD regimen for patients with CLL. FD ibrutinib plus venetoclax achieved deep, durable responses and promising PFS, including in patients with high-risk features.
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Affiliation(s)
- Constantine S. Tam
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
- St. Vincent's Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Thomas J. Kipps
- Moores Cancer Center, University of California San Diego, San Diego, CA
| | | | | | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | | | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Bryone J. Kuss
- Flinders University and Medical Center, Bedford Park, SA, Australia
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Joi Ninomoto
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | - William G. Wierda
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paolo Ghia
- Università Vita-Salute San Raffaele, Milan, Italy
- IRCCS Ospedale San Raffaele, Milan, Italy
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16
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Wierda WG, Barr PM, Siddiqi T, Allan JN, Kipps TJ, Trentin L, Jacobs R, Jackson S, Tedeschi A, Opat S, Bannerji R, Kuss BJ, Moreno C, Croner LJ, Szafer-Glusman E, Zhou C, Szoke A, Dean JP, Ghia P, Tam CSL. Fixed-duration (FD) ibrutinib (I) + venetoclax (V) for first-line (1L) treatment (tx) of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): Three-year follow-up from the FD cohort of the phase 2 CAPTIVATE study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7519 Background: CAPTIVATE (PCYC-1142) is a multicenter phase 2 study of 1L I+V in CLL. The primary analysis (PA) evaluating FD tx with I+V was previously presented (Ghia et al., ASCO 2021). Here we present 3-y follow-up results from the FD cohort. Methods: Patients (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). Responses were investigator assessed per iwCLL 2008 criteria. Undetectable minimal residual disease (uMRD; <10-4) was measured by 8-color flow cytometry. Serious AEs (SAEs) deemed related to I reported >30 d after last dose of study drug were collected. Results: 159 pts were enrolled (median age 60 y), including pts with high-risk features of del(17p)/ TP53 mutation (17%), unmutated IGHV (uIGHV; 56%), and complex karyotype (19%). 147 (92%) and 149 (94%) pts completed tx with I and V, respectively. With 1 y of additional follow-up since PA, median time on study was 39 mo (range 1-41). ORR was 96% and was consistent (96%-97%) in pts with high-risk features (Table).The primary endpoint of complete response (CR) including CR with incomplete bone marrow recovery (CRi) rate in pts without del(17p) (n=136) increased nominally from 56% (95% CI, 48-64) to 58% (95% CI 50-66); in all pts, CR rate increased from 55% (95% CI 48-63) to 57% (95% CI 50-65). In pts achieving CR, 93% had durable responses lasting ≥12 mo post-tx. Of pts with uMRD in peripheral blood at 3 mo post-tx, 66/85 (78%) evaluable pts maintained uMRD through 12-mo post-tx. At 36 mo, PFS was 88% (95% CI 82‒92) and OS was 98% (95% CI 94‒99); similar rates were seen in pts with high-risk features (Table). All pts are off tx; no new SAEs of any kind have occurred since the PA. Available data on relevant mutations in BTK, PLCɣ2, or BCL-2 at time of PD will be presented. As of January 2022, 12 pts were retreated with single-agent I after PD (tx duration range 3-29 mo); of evaluated pts, 7/9 had partial responses and 2/9 had stable disease. Conclusions: Fixed duration I+V continues to provide deep, durable responses and clinically meaningful PFS, including in pts with high-risk disease features, representing an all-oral, once-daily, chemotherapy-free FD regimen for previously untreated pts with CLL/SLL. With an additional 1 y of follow-up, no OS events or SAEs occurred. Manageable safety profile is unchanged as previously reported. To date, successful single-agent I retreatment responses are observed. Clinical trial information: NCT02910583. [Table: see text]
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Affiliation(s)
- William G. Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Ryan Jacobs
- Department of Hematology, Lymphoma Division, Assistant Professor of Medicine, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | | | | | - Stephen Opat
- Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Bryone J. Kuss
- Flinders University and Medical Center, Bedford Park, South Australia, Australia
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - Anita Szoke
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - James P. Dean
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
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Bannerji R, Arnason JE, Advani RH, Brown JR, Allan JN, Ansell SM, Barnes JA, O'Brien SM, Chávez JC, Duell J, Rosenwald A, Crombie JL, Ufkin M, Li J, Zhu M, Ambati SR, Chaudhry A, Lowy I, Topp MS. Odronextamab, a human CD20×CD3 bispecific antibody in patients with CD20-positive B-cell malignancies (ELM-1): results from the relapsed or refractory non-Hodgkin lymphoma cohort in a single-arm, multicentre, phase 1 trial. Lancet Haematol 2022; 9:e327-e339. [PMID: 35366963 PMCID: PMC10681157 DOI: 10.1016/s2352-3026(22)00072-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Odronextamab is a hinge-stabilised, fully human IgG4-based CD20 × CD3 bispecific antibody that binds CD3 on T cells and CD20 on B cells. We aimed to evaluate the safety and antitumour activity of odronextamab in patients with relapsed or refractory B-cell non-Hodgkin lymphoma. METHODS This single-arm, multicentre, phase 1, dose-escalation and dose-expansion (ELM-1) trial was conducted at ten academic sites across the USA and Germany. Patients aged 18 years or older with CD20-positive relapsed or refractory B-cell malignancies who previously received CD20-directed antibody therapy and who had at least one measurable lesion, and an ECOG performance status of 0 or 1 were included. Patients received intravenous odronextamab, according to a step-up dosing schedule in cycle 1, followed by treatment once per week at target doses ranging from 0·1 mg to 320 mg during cycles 2-4 (each cycle was 21 days). After cycle 4, maintenance treatment occurred every 2 weeks until disease progression or unacceptable toxicity. The primary endpoint of safety was assessed by the incidence of adverse events and dose-limiting toxicities to determine the maximum tolerated dose or phase 2 dose of odronextamab, or both. Preliminary antitumour activity, as measured by objective response rate, was a secondary endpoint. This study is registered with ClinicalTrials.gov, NCT02290951. FINDINGS From Feb 4, 2015, to Sept 25, 2021, 145 heavily pretreated patients (median of 3 (IQR 2-5] previous therapies) were enrolled (94 to the dose-escalation and 51 to the dose-expansion part of the study). The median age of patients was 67·0 years (IQR 57·0-73·0); 101 (70%) were male and 44 (30%) were female; most participants were White (119 [82%]) and not Hispanic or Latino (132 [91%]). 42 (29%) patients received previous CAR T therapy and 119 (82%) were refractory to the last line of therapy. Median duration of follow-up was 4·2 months (IQR 1·5-11·5). During dose escalation, odronextamab was administered up to the maximum dose of 320 mg once per week and no dose-limiting toxicities were observed. The recommended dose for expansion in patients with follicular lymphoma grade 1-3a was 80 mg and was 160 mg for patients with diffuse large B-cell lymphoma. Cytokine release syndrome and neurological treatment-emergent adverse events were predominantly low grade and did not result in treatment discontinuation. The most common grade 3 or worse treatment-emergent adverse events were anaemia (36 [25%]), lymphopenia (28 [19%]), hypophosphataemia (27 [19%]), neutropenia (27 [19%]), and thrombocytopenia (20 [14%]). Serious treatment-emergent adverse events occurred in 89 (61%) of 145 patients; the most frequent were cytokine release syndrome (41 [28%]), pyrexia (11 [8%]), pneumonia (nine [6%]), and infusion-related reaction (six [4%]). Four deaths were considered related to treatment (gastric perforation in a patient with gastric involvement by lymphoma, lung infection, pneumonia, and tumour-lysis syndrome). Objective response rate was 51% (95% CI 42-59; 72 of 142). In patients with follicular lymphoma who received odronextamab doses of 5 mg or higher, the objective response rate was 91% (95% CI 75-98; 29 of 32) and the complete response rate was 72% (95% CI 53-86; 23 of 32). In patients with diffuse large B-cell lymphoma without previous CAR T-cell therapy who received doses of 80 mg or higher, the objective response rate was 53% (eight of 15) and all responses were complete responses. In patients with diffuse large B-cell lymphoma who had previous CAR T-cell therapy and received doses of 80 mg or higher, the objective response rate was 33% (ten of 30) and complete response rate was 27% (eight of 30). INTERPRETATION Odronextamab monotherapy showed a manageable safety profile and encouraging preliminary activity, including durable responses in heavily pretreated patients with B-cell non-Hodgkin lymphoma, supporting further clinical investigation in phase 2 and 3 trials. FUNDING Regeneron Pharmaceuticals.
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Affiliation(s)
- Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Jon E Arnason
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | | | | | | | - Johannes Duell
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | | | | | - Jingjin Li
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Min Zhu
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | - Israel Lowy
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
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18
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Allan JN, Shanafelt T, Wiestner A, Moreno C, O’Brien SM, Li J, Krigsfeld G, Dean JP, Ahn IE. Long-term efficacy of first-line ibrutinib treatment for chronic lymphocytic leukaemia in patients with TP53 aberrations: a pooled analysis from four clinical trials. Br J Haematol 2022; 196:947-953. [PMID: 34865212 PMCID: PMC9299890 DOI: 10.1111/bjh.17984] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/22/2021] [Indexed: 01/14/2023]
Abstract
TP53 aberrations [del(17p) or TP53 mutation] predict poor survival with chemoimmunotherapy in patients with chronic lymphocytic leukaemia (CLL). We evaluated long-term efficacy and safety of first-line ibrutinib-based therapy in patients with CLL bearing TP53 aberrations in a pooled analysis across four studies: PCYC-1122e, RESONATE-2 (PCYC-1115/16), iLLUMINATE (PCYC-1130) and ECOG-ACRIN E1912. The pooled analysis included 89 patients with TP53 aberrations receiving first-line treatment with single-agent ibrutinib (n = 45) or ibrutinib in combination with an anti-CD20 antibody (n = 44). All 89 patients had del(17p) (53% of 89 patients) and/or TP53 mutation (91% of 58 patients with TP53 sequencing results available). With a median follow-up of 49·8 months (range, 0·1-95·9), median progression-free survival was not reached. Progression-free survival rate and overall survival rate estimates at four years were 79% and 88%, respectively. Overall response rate was 93%, including complete response in 39% of patients. No new safety signals were identified in this analysis. Forty-six percent of patients remained on ibrutinib treatment at last follow-up. With median follow-up of four years (up to eight years), results from this large, pooled, multi-study data set suggest promising long-term outcomes of first-line ibrutinib-based therapy in patients with TP53 aberrations. Registered at ClinicalTrials.gov (NCT01500733, NCT01722487, NCT02264574 and NCT02048813).
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Affiliation(s)
| | | | | | - Carol Moreno
- Hospital de la Santa Creu i Sant PauAutonomous University of BarcelonaBarcelonaSpain
| | - Susan M. O’Brien
- Chao Family Comprehensive Cancer CenterUniversity of California IrvineIrvineCAUSA
| | - Jianling Li
- Pharmacyclics LLC, an AbbVie CompanySunnyvaleCAUSA
| | | | | | - Inhye E. Ahn
- National Heart, Lung, and Blood InstituteBethesdaMDUSA
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19
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Castillo JJ, Allan JN, Siddiqi T, Advani RH, Meid K, Leventoff C, White TP, Flynn CA, Sarosiek S, Branagan AR, Demos MG, Guerrera ML, Kofides A, Liu X, Munshi M, Tsakmaklis N, Xu L, Yang G, Patterson CJ, Hunter ZR, Davids MS, Furman RR, Treon SP. Venetoclax in Previously Treated Waldenström Macroglobulinemia. J Clin Oncol 2022; 40:63-71. [PMID: 34793256 PMCID: PMC8683218 DOI: 10.1200/jco.21.01194] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE BCL2 is overexpressed and confers prosurvival signaling in malignant lymphoplasmacytic cells in Waldenström macroglobulinemia (WM). Venetoclax is a potent BCL2 antagonist and triggers in vitro apoptosis of WM cells. The activity of venetoclax in WM remains to be clarified. PATIENTS AND METHODS We performed a multicenter, prospective phase II study of venetoclax in patients with previously treated WM (NCT02677324). Venetoclax was dose-escalated from 200 mg to a maximum dose of 800 mg daily for up to 2 years. RESULTS Thirty-two patients were evaluable, including 16 previously exposed to Bruton tyrosine kinase inhibitors (BTKis). All patients were MYD88 L265P-mutated, and 17 carried CXCR4 mutations. The median time to minor and major responses was 1.9 and 5.1 months, respectively. Previous exposure to BTKis was associated with a longer time to response (4.5 v 1.4 months; P < .001). The overall, major, and very good partial response rates were 84%, 81%, and 19%, respectively. The major response rate was lower in those with refractory versus relapsed disease (50% v 95%; P = .007). The median follow-up time was 33 months, and the median progression-free survival was 30 months. CXCR4 mutations did not affect treatment response or progression-free survival. The only recurring grade ≥ 3 treatment-related adverse event was neutropenia (n = 14; 45%), including one episode of febrile neutropenia. Laboratory tumor lysis without clinical sequelae occurred in one patient. No deaths have occurred. CONCLUSION Venetoclax is safe and highly active in patients with previously treated WM, including those who previously received BTKis. CXCR4 mutation status did not affect treatment response.
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Affiliation(s)
- Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA,Jorge J. Castillo, MD, Division of Hematologic Malignancies, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215; e-mail:
| | - John N. Allan
- New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | | | | | - Kirsten Meid
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Carly Leventoff
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Timothy P. White
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Catherine A. Flynn
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA
| | - Andrew R. Branagan
- Harvard Medical School, Boston, MA,Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - Maria G. Demos
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Maria L. Guerrera
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Amanda Kofides
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Xia Liu
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Manit Munshi
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Nicholas Tsakmaklis
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Lian Xu
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Guang Yang
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | | | - Zachary R. Hunter
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA
| | - Matthew S. Davids
- Harvard Medical School, Boston, MA,Division of Lymphoma, Dana-Farber Cancer Institute, Boston, MA
| | - Richard R. Furman
- New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Steven P. Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA
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20
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Allan JN, Pinilla-Ibarz J, Gladstone DE, Patel K, Sharman JP, Wierda WG, Choi MY, O'Brien SM, Shadman M, Davids MS, Pagel JM, Yimer HA, Ward R, Acton G, Taverna P, Combs DL, Fox JA, Furman RR, Brown JR. Phase 1b dose-escalation study of the selective, noncovalent, reversible Bruton's tyrosine kinase inhibitor vecabrutinib in B-cell malignancies. Haematologica 2021; 107:984-987. [PMID: 34937320 PMCID: PMC8968902 DOI: 10.3324/haematol.2021.280061] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- John N Allan
- Weill Cornell Medicine, Department of Medicine, New York
| | | | | | | | - Jeff P Sharman
- Willamette Valley Cancer Institute/US Oncology, Eugene, OR
| | | | - Michael Y Choi
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Susan M O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | | | - Matthew S Davids
- CLL Center, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Renee Ward
- Sunesis Pharmaceuticals, South San Francisco, CA
| | - Gary Acton
- Sunesis Pharmaceuticals, South San Francisco, CA
| | | | | | - Judith A Fox
- Sunesis Pharmaceuticals, South San Francisco, CA
| | | | - Jennifer R Brown
- CLL Center, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
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21
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Wierda WG, Allan JN, Siddiqi T, Kipps TJ, Opat S, Tedeschi A, Badoux XC, Kuss BJ, Jackson S, Moreno C, Jacobs R, Pagel JM, Flinn I, Pak Y, Zhou C, Szafer-Glusman E, Ninomoto J, Dean JP, James DF, Ghia P, Tam CS. Ibrutinib Plus Venetoclax for First-Line Treatment of Chronic Lymphocytic Leukemia: Primary Analysis Results From the Minimal Residual Disease Cohort of the Randomized Phase II CAPTIVATE Study. J Clin Oncol 2021; 39:3853-3865. [PMID: 34618601 PMCID: PMC8713593 DOI: 10.1200/jco.21.00807] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE CAPTIVATE (NCT02910583), a randomized phase II study, evaluates minimal residual disease (MRD)-guided treatment discontinuation following completion of first-line ibrutinib plus venetoclax treatment in patients with chronic lymphocytic leukemia (CLL). METHODS Previously untreated CLL patients age < 70 years received three cycles of ibrutinib and then 12 cycles of combined ibrutinib plus venetoclax. Patients in the MRD cohort who met the stringent random assignment criteria for confirmed undetectable MRD (Confirmed uMRD) were randomly assigned 1:1 to double-blind placebo or ibrutinib; patients without Confirmed uMRD (uMRD Not Confirmed) were randomly assigned 1:1 to open-label ibrutinib or ibrutinib plus venetoclax. Primary end point was 1-year disease-free survival (DFS) rate with placebo versus ibrutinib in the Confirmed uMRD population. Secondary end points included response rates, uMRD, and safety. RESULTS One hundred sixty-four patients initiated three cycles of ibrutinib lead-in. After 12 cycles of ibrutinib plus venetoclax, best uMRD response rates were 75% (peripheral blood) and 68% (bone marrow). Patients with Confirmed uMRD were randomly assigned to receive placebo (n = 43) or ibrutinib (n = 43); patients with uMRD Not Confirmed were randomly assigned to ibrutinib (n = 31) or ibrutinib plus venetoclax (n = 32). Median follow-up was 31.3 months. One-year DFS rate was not significantly different between placebo (95%) and ibrutinib (100%; arm difference: 4.7% [95% CI, -1.6 to 10.9]; P = .15) in the Confirmed uMRD population. After ibrutinib lead-in tumor debulking, 36 of 40 patients (90%) with high tumor lysis syndrome risk at baseline shifted to medium or low tumor lysis syndrome risk categories. Adverse events were most frequent during the first 6 months of ibrutinib plus venetoclax and generally decreased over time. CONCLUSION The 1-year DFS rate of 95% in placebo-randomly assigned patients with Confirmed uMRD suggests the potential for fixed-duration treatment with this all-oral, once-daily, chemotherapy-free regimen in first-line CLL.
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Affiliation(s)
- William G Wierda
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | - Bryone J Kuss
- Flinders University and Medical Centre, Bedford Park, SA, Australia
| | | | - Carol Moreno
- Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - John M Pagel
- Swedish Cancer Institute Center for Blood Disorders and Stem Cell Transplantation, Seattle, WA
| | - Ian Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | - Yvonne Pak
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | - Joi Ninomoto
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - James P Dean
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Constantine S Tam
- Peter MacCallum Cancer Center and St Vincent's Hospital and the University of Melbourne, Melbourne, VIC, Australia
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22
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Forsberg PA, Rossi AC, Boyer A, Pearse RN, Pekle KA, Jayabalan D, Lakritz S, Flicker K, Ribadeneyra D, Liotta B, Ely S, Boussi L, Allan JN, Coleman M, Niesvizky R, Mark TM. Carfilzomib and dexamethasone induction with lenalidomide, clarithromycin and dexamethasone consolidation and lenalidomide maintenance for newly diagnosed multiple myeloma. Am J Hematol 2021; 96:1554-1562. [PMID: 34424561 DOI: 10.1002/ajh.26329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 11/12/2022]
Abstract
Combination treatment regimens including a proteasome inhibitor (PI), an immunomodulatory agent (IMiD) and a corticosteroid are standards of care for initial treatment of multiple myeloma (MM). We aimed to evaluate if a sequential treatment program using PI induction followed by IMiD based consolidation and maintenance could achieve similar outcomes with reduced toxicities. This phase 2 study was designed to assess the safety and efficacy of the Car-BiRd regimen: carfilzomib and dexamethasone (Kd) induction until maximum response, followed by lenalidomide, clarithromycin and dexamethasone (BiRd) consolidation until next maximum response, then lenalidomide maintenance in patients with newly diagnosed MM. Seventy-two patients, including both transplant eligible and ineligible patients, were enrolled and evaluated for response. The overall response rate to the Car-BiRd regimen was 94% with 83% of patients achieving a ≥ VGPR and 35% achieving a CR/sCR. The rate of CR/sCR increased from 7% with Kd induction to 21% with BiRd consolidation and 35% with lenalidomide maintenance. These results did not meet the study's target endpoint of a CR rate of 55%. The median PFS using this deferred transplant approach was 37.3 months (95% CI 27.9, 52.7) and median OS was not reached with a median follow-up of 60 months. Toxicities were primarily low grade and manageable. Hematologic toxicities were lower than those expected with a combination PI/IMiD protocol. The sequential Car-BiRd regimen is an effective and safe approach for the upfront treatment of MM including patients unfit for transplant.
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Affiliation(s)
- Peter A. Forsberg
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
| | - Adriana C. Rossi
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Angelique Boyer
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Roger N. Pearse
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Karen A. Pekle
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - David Jayabalan
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Stephanie Lakritz
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
| | - Kari Flicker
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Drew Ribadeneyra
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Brielle Liotta
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Scott Ely
- Bristol‐Myers Squibb New York New York USA
| | | | - John N. Allan
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Morton Coleman
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Ruben Niesvizky
- Department of Medicine, Division of Hematology/Oncology Weill Medical College of Cornell University, New York Presbyterian Hospital New York New York USA
| | - Tomer M. Mark
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
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Rogers KA, Thompson PA, Allan JN, Coleman M, Sharman JP, Cheson BD, Jones D, Izumi R, Frigault MM, Quah C, Raman RK, Patel P, Wang MH, Kipps TJ. Phase II study of acalabrutinib in ibrutinib-intolerant patients with relapsed/refractory chronic lymphocytic leukemia. Haematologica 2021; 106:2364-2373. [PMID: 33730844 PMCID: PMC8409022 DOI: 10.3324/haematol.2020.272500] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Indexed: 01/01/2023] Open
Abstract
B-cell receptor signaling inhibition by targeting Bruton tyrosine kinase (BTK) is effective in treating chronic lymphocytic leukemia. The BTK inhibitor ibrutinib may be intolerable for some patients. Acalabrutinib is a more selective BTK inhibitor that may be better tolerated by patients who are intolerant to ibrutinib. A phase II study of acalabrutinib was conducted in patients with relapsed/refractory chronic lymphocytic leukemia who were ibrutinib-intolerant and had continued disease activity. Intolerance was defined as having discontinued ibrutinib due to persistent grade 3/4 adverse events or persistent/recurrent grade 2 adverse events despite dose modification/interruption. Patients received oral acalabrutinib 100 mg twice daily until disease progression or intolerance. Sixty patients were treated. The overall response rate to acalabrutinib was 73% and three patients (5%) achieved complete remission. At a median follow-up of 35 months, the median progression-free and overall survival were not reached; 24-month estimates were 72% and 81%, respectively. The most frequent adverse events with acalabrutinib were diarrhea (53%), headache (42%), contusion (40%), dizziness (33%), upper respiratory tract infection (33%), and cough (30%). The most common reasons for acalabrutinib discontinuation were progressive disease (23%) and adverse events (17%). Most patients with baseline samples (49/52; 94%) and all with on-treatment samples (3/3; 100%) had no detectable BTK and/or PLCG2 mutations. Acalabrutinib is effective and tolerable in most patients with relapsed/refractory chronic lymphocytic leukemia who are intolerant of ibrutinib. Acalabrutinib may be useful for patients who may benefit from BTK inhibitor therapy but are ibrutinib intolerant. ClinicalTrials.gov identifier: NCT02717611.
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Helbig DR, Abu‐Zeinah G, Bhavsar E, Christos PJ, Furman RR, Allan JN. Outcomes in CLL patients with NOTCH1 regulatory pathway mutations. Am J Hematol 2021; 96:E187-E189. [PMID: 33625731 DOI: 10.1002/ajh.26140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Daniel R. Helbig
- Division of Hematology and Oncology Weill Cornell Medical College New York New York
| | - Ghaith Abu‐Zeinah
- Division of Hematology and Oncology Weill Cornell Medical College New York New York
| | - Erica Bhavsar
- Division of Hematology and Oncology Weill Cornell Medical College New York New York
| | - Paul J. Christos
- Department of Population Health Sciences Weill Cornell Medical College New York New York
| | - Richard R. Furman
- Division of Hematology and Oncology Weill Cornell Medical College New York New York
| | - John N. Allan
- Division of Hematology and Oncology Weill Cornell Medical College New York New York
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Ghia P, Allan JN, Siddiqi T, Kipps TJ, Jacobs R, Opat S, Barr PM, Tedeschi A, Trentin L, Bannerji R, Jackson S, Kuss B, Moreno C, Szafer-Glusman E, Russell K, Zhou C, Ninomoto JS, Dean JP, Wierda WG, Tam CSL. 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. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7501] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7501 Background: CAPTIVATE (PCYC-1142) is a multicenter phase 2 study of first-line I+V in CLL. We previously 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 results 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, tumor lysis syndrome (TLS) risk reduction, and adverse events (AEs). Results: 159 pts were enrolled (median 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 after 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 decreased (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 appear 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. [Table: see text]
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Affiliation(s)
- Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Thomas J. Kipps
- University of California San Diego Moores Cancer Center, La Jolla, CA
| | | | | | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Byrone Kuss
- Flinders University and Medical Centre, Bedford Park, SA, Australia
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | | | - William G. Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Constantine Si Lun Tam
- Peter MacCallum Cancer Centre & St. Vincent's Hospital and the University of Melbourne, Melbourne, Australia
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Eyre TA, Lamanna N, Roeker LE, Ujjani CS, Hill BT, Barr PM, Lansigan E, Cheson BD, Yazdy M, Allan JN, Rhodes J, Schuster SJ, Nabhan C, Skarbnik A, Leslie L, Islam P, Whitaker K, Coombs CC, Tuncer HH, Pagel JM, Jacobs R, Winter AM, Bailey N, Sitlinger A, Schuh AH, Follows G, Fox CP, Brander DM, Shadman M, Mato AR. Comparative analysis of targeted novel therapies in relapsed, refractory chronic lymphocytic leukaemia. Haematologica 2021; 106:284-287. [PMID: 32079693 PMCID: PMC7776352 DOI: 10.3324/haematol.2019.241539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Toby A Eyre
- Hematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Nicole Lamanna
- New York-Presbyterian Columbia University Medical Center, New York, NY
| | | | - Chaitra S Ujjani
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Brian T Hill
- Dept. of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation
| | - Paul M Barr
- Division of Hematology/Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | - Bruce D Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Maryam Yazdy
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | - John N Allan
- Weill Cornell Medicine School of Medicine, Long Island City, NY
| | - Joanna Rhodes
- Div. of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen J Schuster
- Div of Hematology and Oncology,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | - Lori Leslie
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - Prioty Islam
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | | | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Hande H Tuncer
- Department of Medicine, Cancer Center, Tufts Medical Center, Boston, MA
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA
| | - Ryan Jacobs
- Department of Hematology, Lymphoma Division, Levine Cancer Institute, Charlotte, NC
| | - Allison M Winter
- Dept of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation
| | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA
| | - Andrea Sitlinger
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | - Anna H Schuh
- Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
| | | | | | - Danielle M Brander
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | - Mazyar Shadman
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, WA
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Cuneo A, Mato AR, Rigolin GM, Piciocchi A, Gentile M, Laurenti L, Allan JN, Pagel JM, Brander DM, Hill BT, Winter A, Lamanna N, Tam CS, Jacobs R, Lansigan F, Barr PM, Shadman M, Skarbnik AP, Pu JJ, Sehgal AR, Schuster SJ, Shah NN, Ujjani CS, Roeker L, Orlandi EM, Billio A, Trentin L, Spacek M, Marchetti M, Tedeschi A, Ilariucci F, Gaidano G, Doubek M, Farina L, Molica S, Di Raimondo F, Coscia M, Mauro FR, de la Serna J, Medina Perez A, Ferrarini I, Cimino G, Cavallari M, Cucci R, Vignetti M, Foà R, Ghia P. Efficacy of bendamustine and rituximab in unfit patients with previously untreated chronic lymphocytic leukemia. Indirect comparison with ibrutinib in a real-world setting. A GIMEMA-ERIC and US study. Cancer Med 2020; 9:8468-8479. [PMID: 32969597 PMCID: PMC7666748 DOI: 10.1002/cam4.3470] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/29/2022] Open
Abstract
Limited information is available on the efficacy of front‐line bendamustine and rituximab (BR) in chronic lymphocytic leukemia (CLL) with reduced renal function or coexisting conditions. We therefore analyzed a cohort of real‐world patients and performed a matched adjusted indirect comparison with a cohort of patients treated with ibrutinib. One hundred and fifty‐seven patients with creatinine clearance (CrCl) <70 mL/min and/or CIRS score >6 were treated with BR. The median age was 72 years; 69% of patients had ≥2 comorbidities and the median CrCl was 59.8 mL/min. 17.6% of patients carried TP53 disruption. The median progression‐free survival (PFS) was 45 months; TP53 disruption was associated with a shorter PFS (P = 0.05). The overall survival (OS) at 12, 24, and 36 months was 96.2%, 90.1%, and 79.5%, respectively. TP53 disruption was associated with an increased risk of death (P = 0.01). Data on 162 patients ≥65 years treated with ibrutinib were analyzed and compared with 165 patients ≥65 years treated with BR. Factors predicting for a longer PFS at multivariable analysis in the total patient population treated with BR and ibrutinib were age (HR 1.06, 95% CI 1.02‐1.10, P < 0.01) and treatment with ibrutinib (HR 0.55, 95% CI 0.33‐0.93, P = 0.03). In a post hoc analysis of patients in advanced stage, a significant PFS advantage was observed in patient who had received ibrutinib (P = 0.03), who showed a trend for OS advantage (P = 0.08). We arrived at the following conclusions: (a) BR is a relatively effective first‐line regimen in a real‐world population of unfit patients without TP53 disruption, (b) ibrutinib provided longer disease control than BR in patients with advanced disease stage.
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Affiliation(s)
- Antonio Cuneo
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Anthony R Mato
- Division of Hematological Oncology, CLL Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Massimo Gentile
- Department of Onco-Hematology, Hematology Unit, A.O. of Cosenza, Cosenza, Italy
| | - Luca Laurenti
- Department of Radiological, Radiotherapeutic and Hematological Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allison Winter
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Constantine S Tam
- Peter McCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | | | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Alan P Skarbnik
- Lymphoproliferative Disorders Program, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Jeffrey J Pu
- SUNY Upstate Medical University, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Stephen J Schuster
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chaitra S Ujjani
- Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Lindsey Roeker
- Division of Hematological Oncology, CLL Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Atto Billio
- Hematology and Transplant Unit, San Maurizio Hospital, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology, Department of Medicine, University of Padua, Padua, Italy
| | - Martin Spacek
- Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Alessandra Tedeschi
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of eastern Piedmont, Novara, Italy
| | - Michael Doubek
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucia Farina
- Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Stefano Molica
- Hematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | | | | | - Isacco Ferrarini
- Hematology, Department of Cell Therapy and Hematology, University Hospital, Verona, Italy
| | - Giuseppe Cimino
- Department of Translational and Precision Medicine, University "La Sapienza", UOC di Ematologia con Trapianto, Ospedale S. Maria Goretti, Latina, Italy
| | - Maurizio Cavallari
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Rosalba Cucci
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | - Paolo Ghia
- Strategic Research Program on CLL, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
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28
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Ujjani C, Mato A, Hill BT, Allan JN, Lansigan F, Jacobs R, Skarbnik A, Tuncer H, Pagel J, Brander D, Cheson B, Barr P, Roeker LE, Pu J, Shah NN, Goy A, Schuster SJ, Lamanna N, Sehgal A, Tam CS, Shadman M. The Impact of Age on Survival in CLL Patients Receiving Ibrutinib as Initial Therapy. Blood Lymphat Cancer 2020; 10:1-5. [PMID: 32943973 PMCID: PMC7473982 DOI: 10.2147/blctt.s262592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/10/2020] [Indexed: 12/29/2022]
Abstract
Introduction Recent randomized trials have demonstrated the efficacy of ibrutinib-based therapy in the treatment of patients with CLL. In Alliance A041202, a higher than expected number of unexplained deaths were reported with front-line ibrutinib in a patient population aged at least 65 years compared to ECOG 1912, which included patients up to 70 years of age. Methods Therefore, we conducted a retrospective analysis to investigate whether ibrutinib was associated with a greater mortality in older patients outside of a clinical trial setting. This multicenter analysis was performed by investigators at 20 academic and community practices. Results Amongst the 391 patients included, there was no correlation between age and response rate, PFS, or OS. However, there was a trend to higher rate of deaths in patients >65-years-old (8.7% vs 3.8%, p=0.097), with an increased number of early deaths (13 vs 4, p=0.3). Conclusion These data suggest greater intolerance, and possibly mortality, with ibrutinib in an older population. Patients should be educated regarding the potential complications related to ibrutinib and symptoms of concern to report.
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Affiliation(s)
- Chaitra Ujjani
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anthony Mato
- Division of Hematological Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John N Allan
- Division of Hematology and Medical Oncology, New York Presbyterian & Weill Cornell, New York, NY, USA
| | - Frederick Lansigan
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Charlotte, NC, USA
| | - Alan Skarbnik
- Novant Health Cancer Institute, Charlotte, NC 28204, USA
| | - Hande Tuncer
- Lowell General Hospital, Tufts Medical Center, Boston, MA, USA
| | - John Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Danielle Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Bruce Cheson
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
| | - Paul Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Lindsey E Roeker
- Division of Hematological Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey Pu
- Division of Hematology/Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Stephen J Schuster
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Alison Sehgal
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Constantine S Tam
- Peter McCallum Cancer Centre, University of Melbourne, East Melbourne, VI, Australia
| | - Mazyar Shadman
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Mato AR, Roeker LE, Jacobs R, Hill BT, Lamanna N, Brander D, Shadman M, Ujjani CS, Yazdy MS, Perini GF, Pinilla-Ibarz JA, Barrientos J, Skarbnik AP, Torka P, Pu JJ, Pagel JM, Gohil S, Fakhri B, Choi M, Coombs CC, Rhodes J, Barr PM, Portell CA, Parry H, Garcia CA, Whitaker KJ, Winter AM, Sitlinger A, Khajavian S, Grajales-Cruz AF, Isaac KM, Shah P, Akhtar OS, Pocock R, Lam K, Voorhees TJ, Schuster SJ, Rodgers TD, Fox CP, Martinez-Calle N, Munir T, Bhavsar EB, Bailey N, Lee JC, Weissbrot HB, Nabhan C, Goodfriend JM, King AC, Zelenetz AD, Dorsey C, Bigelow K, Cheson BD, Allan JN, Eyre TA. Assessment of the Efficacy of Therapies Following Venetoclax Discontinuation in CLL Reveals BTK Inhibition as an Effective Strategy. Clin Cancer Res 2020; 26:3589-3596. [PMID: 32198151 PMCID: PMC8588795 DOI: 10.1158/1078-0432.ccr-19-3815] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/05/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Venetoclax-based therapy is a standard-of-care option in first-line and relapsed/refractory chronic lymphocytic leukemia (CLL). Patient management following venetoclax discontinuation remains nonstandard and poorly understood. EXPERIMENTAL DESIGN To address this, we conducted a large international study to identify a cohort of 326 patients who discontinued venetoclax and have been subsequently treated. Coprimary endpoints were overall response rate (ORR) and progression-free survival for the post-venetoclax treatments stratified by treatment type [Bruton's tyrosine kinase inhibitor (BTKi), PI3K inhibitor (PI3Ki), and cellular therapies]. RESULTS We identified patients with CLL who discontinued venetoclax in the first-line (4%) and relapsed/refractory settings (96%). Patients received a median of three therapies prior to venetoclax; 40% were BTKi naïve (n = 130), and 81% were idelalisib naïve (n = 263). ORR to BTKi was 84% (n = 44) in BTKi-naïve patients versus 54% (n = 30) in BTKi-exposed patients. We demonstrate therapy selection following venetoclax requires prior novel agent exposure consideration and discontinuation reasons. CONCLUSIONS For BTKi-naïve patients, selection of covalently binding BTKis results in high ORR and durable remissions. For BTKi-exposed patients, covalent BTK inhibition is not effective in the setting of BTKi resistance. PI3Kis following venetoclax do not appear to result in durable remissions. We conclude that BTKi in naïve or previously responsive patients and cellular therapies following venetoclax may be the most effective strategies.See related commentary by Rogers, p. 3501.
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Affiliation(s)
- Anthony R Mato
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | | | - Ryan Jacobs
- Department of Hematology, Lymphoma Division, Levine Cancer Institute, Charlotte, North Carolina
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | | | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Chaitra S Ujjani
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Maryam Sarraf Yazdy
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington D.C
| | | | | | | | | | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Jeffrey J Pu
- SUNY Upstate Medical University, Syracuse, New York
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, Washington
| | - Satyen Gohil
- University College London, London, United Kingdom
| | - Bita Fakhri
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Michael Choi
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Joanna Rhodes
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul M Barr
- Division of Hematology/Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Craig A Portell
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | - Helen Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Christine A Garcia
- Hillman Cancer Pavilion, Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Allison M Winter
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrea Sitlinger
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | | | | | - Krista M Isaac
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | | | | | | | - Kentson Lam
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Timothy J Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen J Schuster
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Christopher P Fox
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Nicolas Martinez-Calle
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, England, United Kingdom
| | - Talha Munir
- Weill Cornell Medicine, Long Island City, New York
| | - Erica B Bhavsar
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, Washington
| | - Jason C Lee
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | - Hanna B Weissbrot
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | | | | | - Amber C King
- Clinical Pharmacy Specialist-Leukemia, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colleen Dorsey
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kayla Bigelow
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington D.C
| | - John N Allan
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Toby A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Arruga F, Bracciamà V, Vitale N, Vaisitti T, Gizzi K, Yeomans A, Coscia M, D'Arena G, Gaidano G, Allan JN, Furman RR, Packham G, Forconi F, Deaglio S. Correction: Bidirectional linkage between the B-cell receptor and NOTCH1 in chronic lymphocytic leukemia and in Richter's syndrome: therapeutic implications. Leukemia 2020; 34:1721. [PMID: 31836851 DOI: 10.1038/s41375-019-0680-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Francesca Arruga
- Department of Medical Sciences, University of Turin, Turin, Italy.
| | | | - Nicoletta Vitale
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Tiziana Vaisitti
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Alison Yeomans
- Cancer Sciences Unit, Haematological Oncology Group, University of Southampton, Southampton, UK
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giovanni D'Arena
- Hematology and Stem Cell Transplantation Unit, IRCCS Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - John N Allan
- Department of Hematology, Weill Cornell Medicine, New York, NY, USA
| | - Richard R Furman
- Department of Hematology, Weill Cornell Medicine, New York, NY, USA
| | - Graham Packham
- Cancer Sciences Unit, Haematological Oncology Group, University of Southampton, Southampton, UK
| | - Francesco Forconi
- Cancer Sciences Unit, Haematological Oncology Group, University of Southampton, Southampton, UK
| | - Silvia Deaglio
- Department of Medical Sciences, University of Turin, Turin, Italy.
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31
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Eyre TA, Roeker LE, Fox CP, Gohill SH, Walewska R, Walter HS, Forconi F, Broom A, Arumainathan A, Brander DM, Allan JN, Schuster SJ, Hill BT, Lansigan F, Cheson BD, Lamanna N, Coombs CC, Barr PM, Skarbnik AP, Shadman M, Ujjani CS, Pearson L, Pagel JM, Jacobs R, Mato AR. The efficacy and safety of venetoclax therapy in elderly patients with relapsed, refractory chronic lymphocytic leukaemia. Br J Haematol 2020; 188:918-923. [PMID: 31682002 PMCID: PMC7528953 DOI: 10.1111/bjh.16271] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
Abstract
Elderly chronic lymphocytic leukaemia (CLL) patients treated outside of trials have notably greater toxicity with the Bruton's tyrosine kinase inhibitor ibrutinib compared to younger patients. It is not known whether the same holds true for the B-cell lymphoma 2 inhibitor venetoclax. We provide a comprehensive analysis of key safety measures and efficacy in 342 patients comparing age categories ≥75 and <75 years treated in the relapsed, refractory non-trial setting. We demonstrate that venetoclax has equivalent efficacy and safety in relapsed/refractory CLL patients who are elderly, the majority of whom are previous ibrutinib-exposed and therefore may otherwise have few clear therapeutic options.
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Affiliation(s)
- Toby A. Eyre
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lindsey E. Roeker
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Christopher P. Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Foundation Trust, Nottingham
| | - Satyen H. Gohill
- Department of Haematology, University College London Hospitals, London
| | - Renata Walewska
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth
| | | | - Francesco Forconi
- Department of Haematology, University Hospital Trust and Cancer Sciences Unit, Cancer Research
- National Institute for Health Research Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton
| | - Angus Broom
- Department of Haematology, Western General Hospital, Edinburgh
| | | | | | - John N. Allan
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY
| | - Stephen J. Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Brian T. Hill
- Department of Hematology & Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Bruce D. Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC
| | - Nicole Lamanna
- Hematology/Oncology Division, Columbia University Medical Center, New York, NY
| | - Catherine C. Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | | | | | | | | | - Ryan Jacobs
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | - Anthony R. Mato
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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32
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Arruga F, Bracciamà V, Vitale N, Vaisitti T, Gizzi K, Yeomans A, Coscia M, D'Arena G, Gaidano G, Allan JN, Furman RR, Packham G, Forconi F, Deaglio S. Bidirectional linkage between the B-cell receptor and NOTCH1 in chronic lymphocytic leukemia and in Richter's syndrome: therapeutic implications. Leukemia 2020; 34:462-477. [PMID: 31467429 DOI: 10.1038/s41375-019-0571-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/12/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022]
Abstract
NOTCH1 mutations in chronic lymphocytic leukemia (CLL) lead to accumulation of NOTCH1 intracellular domain (NICD) and prolong signaling. These mutations associate with a more aggressive disease compared to wild-type (WT) CLL. In this work we demonstrate a bidirectional functional relationship between NOTCH1 and the B cell receptor (BCR) pathways. By using highly homogeneous cohorts of primary CLL cells, activation of NOTCH1 is shown to increase expression of surface IgM, as well as LYN, BTK, and BLNK, ultimately enhancing BCR signaling responses, including global mRNA translation. Upon BCR cross-linking, NOTCH1 itself is actively translated and increased on cell surface. Furthermore, BCR ligation induces calcium mobilization that can facilitate ligand-independent NOTCH1 activation. These data suggest that the two pathways are functionally linked, providing a rationale for dual inhibition strategies. Consistently, addition of the γ-secretase inhibitor DAPT to ibrutinib significantly potentiates its effects, both in vitro and in a short-term patient-derived xenograft model. While this observation may find limited applications in the CLL field, it is more relevant for Richter's Syndrome (RS) management, where very few successful therapeutic options exist. Treatment of RS-patient-derived xenografts (RS-PDX) with the combination of ibrutinib and DAPT decreases disease burden and increases overall survival.
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MESH Headings
- Adenine/analogs & derivatives
- Adult
- Aged
- Aged, 80 and over
- Amyloid Precursor Protein Secretases/metabolism
- Animals
- Calcium/metabolism
- Diamines/therapeutic use
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Male
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Middle Aged
- Piperidines
- Pyrazoles/therapeutic use
- Pyrimidines/therapeutic use
- Receptor, Notch1/metabolism
- Receptors, Antigen, B-Cell/metabolism
- Signal Transduction/drug effects
- Syndrome
- Thiazoles/therapeutic use
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Affiliation(s)
- Francesca Arruga
- Department of Medical Sciences, University of Turin, Turin, Italy.
| | | | - Nicoletta Vitale
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Tiziana Vaisitti
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Alison Yeomans
- Cancer Sciences Unit, Haematological Oncology Group, University of Southampton, Southampton, UK
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giovanni D'Arena
- Hematology and Stem Cell Transplantation Unit, IRCCS Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - John N Allan
- Department of Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Richard R Furman
- Department of Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Graham Packham
- Cancer Sciences Unit, Haematological Oncology Group, University of Southampton, Southampton, UK
| | - Francesco Forconi
- Cancer Sciences Unit, Haematological Oncology Group, University of Southampton, Southampton, UK
| | - Silvia Deaglio
- Department of Medical Sciences, University of Turin, Turin, Italy.
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Affiliation(s)
- John N Allan
- a Division of Hematology and Medical Oncology, Department of Medicine , New York-Presbyterian Hospital/Weill Cornell Medicine , New York , NY , USA
| | - Koen Van Besien
- a Division of Hematology and Medical Oncology, Department of Medicine , New York-Presbyterian Hospital/Weill Cornell Medicine , New York , NY , USA
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34
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Helbig DR, Abu Zeinah GF, Bhavsar EB, Allan JN. Outcomes in chronic lymphocytic leukemia (CLL) patients with NOTCH1 signaling pathway mutations. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7524 Background: NOTCH1 is one of the most frequently mutated genes in CLL and has emerged as a marker of poor prognosis. Additional mutations in the NOTCH1 signaling pathway, specifically MED12, FBXW7, and SPEN, have been identified in CLL but their clinical significance has yet to be fully determined. We evaluated the clinical outcome of time to first treatment (TTFT) to compare patients with mutations to those who are wild type for NOTCH1, MED12, FBXW7, and SPEN, hypothesizing that patients with these mutations will behave similarly to NOTCH1 mutated patients and have a shorter TTFT. Methods: We conducted a single center retrospective database review of 506 patients diagnosed with CLL from 1980 to 2018 who underwent whole exome profiling between 2015 to 2018 with a lymphoid specific 75-gene next generation sequencing (NGS) panel (Genoptix Inc). The TTFT was estimated using Kaplan-Meier methods, and the difference between groups was compared using the log-rank test. Multivariate analysis (MVA) was performed with Cox proportional hazards regression. Results: Of the 506 patients who underwent NGS testing, 121 (23.9%) had at least one mutation in the NOTCH1 signaling pathway. These patients were diagnosed at an older age (62.0 years vs. 60.0 years, p=0.04) and had higher rates of CD38 positivity (40.9% vs. 22.9%, p≤0.001), Trisomy 12 (36.0% vs. 15.8%, p≤0.001), and IGVH unmutated status (71.3% vs. 44.1%, p≤0.001). They also had a shorter TTFT with a median of 3.93 years compared to 5.02 years in patients without any mutation in the NOTCH1 signaling pathway (p=0.002). In MVA, IGVH unmutated status and CD38 positivity remained independently predictive for TTFT. Conclusions: We identified three mutations in genes associated with regulation of NOTCH1 signaling that appear to signify poor prognosis, predict for a shorter TTFT, and associate with similar baseline factors that NOTCH1 does such as Trisomy 12 and IGVH unmutated status. NOTCH1 mutated patients have poor response to chemoimmunotherapy and are associated with aggressive disease biology. Future research is needed to determine whether mutations in MED12, FBXW7, or SPEN may also predict for poor response to frontline chemoimmunotherapy or novel agents currently used in CLL.
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Affiliation(s)
- Daniel R. Helbig
- Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Ghaith F Abu Zeinah
- Department of Hematology and Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Erica B. Bhavsar
- Department of Hematology and Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - John N. Allan
- Department of Hematology and Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
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35
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Gaiti F, Chaligne R, Gu H, Brand RM, Kothen-Hill S, Schulman R, Grigorev K, Risso D, Kim KT, Pastore A, Huang KY, Alonso A, Sheridan C, Omans ND, Biederstedt E, Clement K, Wang L, Felsenfeld JA, Bhavsar EB, Aryee MJ, Allan JN, Furman R, Gnirke A, Wu CJ, Meissner A, Landau DA. Epigenetic evolution and lineage histories of chronic lymphocytic leukaemia. Nature 2019; 569:576-580. [PMID: 31092926 PMCID: PMC6533116 DOI: 10.1038/s41586-019-1198-z] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/12/2019] [Indexed: 11/22/2022]
Abstract
Genetic and epigenetic intra-tumoral heterogeneity cooperate to shape the evolutionary course of cancer1. Chronic lymphocytic leukaemia (CLL) is a highly informative model for cancer evolution as it undergoes substantial genetic diversification and evolution after therapy2,3. The CLL epigenome is also an important disease-defining feature4,5, and growing populations of cells in CLL diversify by stochastic changes in DNA methylation known as epimutations6. However, previous studies using bulk sequencing methods to analyse the patterns of DNA methylation were unable to determine whether epimutations affect CLL populations homogeneously. Here, to measure the epimutation rate at single-cell resolution, we applied multiplexed single-cell reduced-representation bisulfite sequencing to B cells from healthy donors and patients with CLL. We observed that the common clonal origin of CLL results in a consistently increased epimutation rate, with low variability in the cell-to-cell epimutation rate. By contrast, variable epimutation rates across healthy B cells reflect diverse evolutionary ages across the trajectory of B cell differentiation, consistent with epimutations serving as a molecular clock. Heritable epimutation information allowed us to reconstruct lineages at high-resolution with single-cell data, and to apply this directly to patient samples. The CLL lineage tree shape revealed earlier branching and longer branch lengths than in normal B cells, reflecting rapid drift after the initial malignant transformation and a greater proliferative history. Integration of single-cell bisulfite sequencing analysis with single-cell transcriptomes and genotyping confirmed that genetic subclones mapped to distinct clades, as inferred solely on the basis of epimutation information. Finally, to examine potential lineage biases during therapy, we profiled serial samples during ibrutinib-associated lymphocytosis, and identified clades of cells that were preferentially expelled from the lymph node after treatment, marked by distinct transcriptional profiles. The single-cell integration of genetic, epigenetic and transcriptional information thus charts the lineage history of CLL and its evolution with therapy.
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Affiliation(s)
- Federico Gaiti
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA
| | - Ronan Chaligne
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA
| | - Hongcang Gu
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Ryan Matthew Brand
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA
| | - Steven Kothen-Hill
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA
| | - Rafael Schulman
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA
| | | | - Davide Risso
- Weill Cornell Medicine, New York, NY, 10021, USA,Department of Statistical Sciences, University of Padova, Padova, 35121, Italy
| | - Kyu-Tae Kim
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA
| | - Alessandro Pastore
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Kevin Y. Huang
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA
| | | | | | - Nathaniel D. Omans
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA
| | - Evan Biederstedt
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA
| | - Kendell Clement
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Lili Wang
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA,Beckman Research Institute, City of Hope, Monrovia, CA, 91016, USA
| | | | | | - Martin J. Aryee
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA,Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | | | | | - Andreas Gnirke
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Catherine J. Wu
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA,Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Alexander Meissner
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA,Max Planck Institute for Molecular Genetics, Berlin, 14195, Germany
| | - Dan A. Landau
- New York Genome Center, New York, NY, 10013, USA,Weill Cornell Medicine, New York, NY, 10021, USA,Corresponding author: Dan A. Landau, MD, PhD, Weill Cornell Medicine, Belfer Research Building, 413 East 69th Street, New York, NY 10021,
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36
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Forsberg PA, Rossi AC, Boyer A, Tegnestam L, Pearse RN, Perry A, Pekle KA, Jayabalan D, Ely S, Boussi L, Sherbenou DW, Williams C, Allan JN, Coleman M, Niesvizky R, Mark TM. Phase II study of carfilzomib and dexamethasone therapy for newly diagnosed multiple myeloma. Am J Hematol 2019; 94:539-545. [PMID: 30740766 DOI: 10.1002/ajh.25435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/09/2019] [Accepted: 02/07/2019] [Indexed: 11/10/2022]
Abstract
Carfilzomib and dexamethasone (Kd) has significant activity in relapsed and refractory multiple myeloma. Kd has not previously been evaluated in newly diagnosed multiple myeloma (NDMM). We report a single-arm phase 2 study of 72 patients with NDMM to evaluate the efficacy and tolerability of Kd induction. Carfilzomib was administered in two dosing cohorts with dosing of 20/45 mg/m2 in the first 25 patients and 20/56 mg/m2 in the subsequent 47 patients. Carfilzomib was administered on days 1, 2, 8, 9, 15 and 16 of a 28-day cycle, dexamethasone 20 mg was administered orally on days 1, 2, 8, 9, 15, 16, 22 and 23. Treatment was continued to maximum response, progression of disease, or regimen intolerability. Endpoints included overall response rate (ORR), regimen toxicity and impact of carfilzomib on CD34+ stem cell collection yield. Sixty-five pts achieved at least a partial response (PR) for an ORR of 90%. The maximum response achieved was complete response or better in 5 (7%), very good partial response (VGPR) in 42 (58%), PR in 18 (25%) and stable disease in 7 pts (10%). Toxicities were predominantly low grade with 547 grade 1/2 adverse events and 44 grade ≥3 events. The rate of grade ≥3 cardiovascular adverse events was 11.1% with eight observed events. The activity of Kd described represents the highest rate of overall response and ≥VGPR for any 2-agent combination in NDMM reported to date. Kd demonstrated a safety profile consistent with previously reported carfilzomib studies.
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Affiliation(s)
- Peter A. Forsberg
- Department of Medicine, Division of HematologyUniversity of Colorado School of Medicine Aurora Colorado
| | - Adriana C. Rossi
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - Angelique Boyer
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - Linda Tegnestam
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - Roger N. Pearse
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - Arthur Perry
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - Karen A. Pekle
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - David Jayabalan
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - Scott Ely
- Department of Pathology, Bristol‐Myers Squibb New York New York
| | | | - Daniel W. Sherbenou
- Department of Medicine, Division of HematologyUniversity of Colorado School of Medicine Aurora Colorado
| | - Colt Williams
- Department of Medicine, Division of HematologyUniversity of Colorado School of Medicine Aurora Colorado
| | - John N. Allan
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - Morton Coleman
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - Ruben Niesvizky
- Department of Medicine, Division of Hematology/OncologyWeill Medical College of Cornell University, New York Presbyterian Hospital New York New York
| | - Tomer M. Mark
- Department of Medicine, Division of HematologyUniversity of Colorado School of Medicine Aurora Colorado
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37
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Roeker LE, Fox CP, Eyre TA, Brander DM, Allan JN, Schuster SJ, Nabhan C, Hill BT, Shah NN, Lansigan F, Yazdy M, Cheson BD, Lamanna N, Singavi AK, Coombs CC, Barr PM, Skarbnik AP, Shadman M, Ujjani CS, Tuncer HH, Winter AM, Rhodes J, Dorsey C, Morse H, Kabel C, Pagel JM, Williams AM, Jacobs R, Goy A, Muralikrishnan S, Pearson L, Sitlinger A, Bailey N, Schuh A, Kirkwood AA, Mato AR. Tumor Lysis, Adverse Events, and Dose Adjustments in 297 Venetoclax-Treated CLL Patients in Routine Clinical Practice. Clin Cancer Res 2019; 25:4264-4270. [PMID: 31004001 DOI: 10.1158/1078-0432.ccr-19-0361] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/08/2019] [Accepted: 04/15/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Clinical trials of venetoclax reported negligible rates of clinical tumor lysis syndrome (TLS) in patients with chronic lymphocytic leukemia (CLL) when using an extended dose escalation schedule. We aimed to understand TLS prophylaxis, rates of select adverse events (AE), and impact of dosing modifications in routine clinical practice. EXPERIMENTAL DESIGN This retrospective cohort study included 297 CLL venetoclax-treated patients outside of clinical trials in academic and community centers. Demographics, baseline disease characteristics, venetoclax dosing, TLS risk and prophylaxis, and AEs were collected. RESULTS The group was 69% male, 96% had relapsed/refractory CLL, 45% had deletion chromosome 17p, 84% had unmutated IGHV, 80% received venetoclax monotherapy, and median age was 67. TLS risk was categorized as low (40%), intermediate (32%), or high (28%), and 62% had imaging prior to venetoclax initiation. Clinical TLS occurred in 2.7% of patients and laboratory TLS occurred in 5.7%. Pre-venetoclax TLS risk group and creatinine clearance independently predict TLS development in multivariable analysis. Grade 3/4 AEs included neutropenia (39.6%), thrombocytopenia (29.2%), infection (25%), neutropenic fever (7.9%), and diarrhea (6.9%). Twenty-two patients (7.4%) discontinued venetoclax due to an AE. Progression-free survival was similar regardless of number of dose interruptions, length of dose interruption, and stable venetoclax dose. CONCLUSIONS These data provide insights into current use of venetoclax in clinical practice, including TLS rates observed in clinical practice. We identified opportunities for improved adherence to TLS risk stratification and prophylaxis, which may improve safety.
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Affiliation(s)
- Lindsey E Roeker
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Christopher P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, United Kingdom
| | - Toby A Eyre
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Danielle M Brander
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina
| | - John N Allan
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Maryam Yazdy
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, D
| | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, D
| | - Nicole Lamanna
- Hematology/Oncology Division, Columbia University Medical Center, New York, New York
| | - Arun K Singavi
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Alan P Skarbnik
- John Theurer Cancer Center, Hackensack University Medical Center, Closter, New Jersey
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Joanna Rhodes
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colleen Dorsey
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hannah Morse
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Charlene Kabel
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | - Ryan Jacobs
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Closter, New Jersey
| | | | | | - Andrea Sitlinger
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina
| | - Neil Bailey
- Swedish Cancer Institute, Seattle, Washington
| | - Anna Schuh
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Amy A Kirkwood
- Cancer Research UK and University College London Cancer Trials Centre, London, United Kingdom
| | - Anthony R Mato
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
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Abstract
Richter's syndrome (RS) is a life-threatening complication of chronic lymphocytic leukemia (CLL). While previous research has increased our knowledge on the distinct evolutionary patterns of RS and provided a deeper understanding of the risk factors and molecular events predisposing to transformation, there remain few targetable aberrations and treatment is largely ineffective. The ability to obtain deeper remissions, without selecting for deletion 17p, by using novel B-cell receptor (BCR) antagonists and bcl2 inhibition might lead to a decrease in the incidence of RS, but these agents have done little to significantly change outcomes when incorporated into treatment regimens for RS. In this review we highlight the current landscape of molecular lesions specific to RS, review the data on historical treatment options, and look to the horizon for potential opportunities in the future.
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Affiliation(s)
- John N Allan
- Department of Medicine, Division of Hematology & Medical Oncology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Richard R Furman
- Department of Medicine, Division of Hematology & Medical Oncology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
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39
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Mato AR, Roeker LE, Allan JN, Pagel JM, Brander DM, Hill BT, Cheson BD, Furman RR, Lamanna N, Tam CS, Handunnetti S, Jacobs R, Lansigan F, Bhavsar E, Barr PM, Shadman M, Skarbnik AP, Goy A, Beach DF, Svoboda J, Pu JJ, Sehgal AR, Zent CS, Tuncer HH, Schuster SJ, Pickens PV, Shah NN, Rhodes J, Ujjani CS, Nabhan C. Outcomes of front-line ibrutinib treated CLL patients excluded from landmark clinical trial. Am J Hematol 2018; 93:1394-1401. [PMID: 30132965 DOI: 10.1002/ajh.25261] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 12/11/2022]
Abstract
Ibrutinib demonstrated superior response rates and survival for treatment-naïve chronic lymphocytic leukemia (CLL) patients in a pivotal study that excluded patients younger than 65 (<65) and/or with chromosome 17p13 deletion (del[17p13]). We examined outcomes and toxicities of CLL patients who would have been excluded from the pivotal study, specifically <65 and/or those with del[17p13]. This multicenter, retrospective cohort study examined CLL patients treated with front-line ibrutinib at 20 community and academic centers, categorizing them based on key inclusion criteria for the RESONATE-2 trial: <65 vs ≥65 and present vs absent del[17p13]. Of 391 included patients, 57% would have been excluded from the pivotal study. Forty-one percent of our cohort was <65, and 30% had del(17p13). Patients <65 were more likely to start 420 mg of ibrutinib daily; those who started at reduced doses had inferior PFS. The most common adverse events were arthralgias, fatigue, rash, bruising, and diarrhea. Twenty-four percent discontinued ibrutinib at 13.8 months median follow-up; toxicity was the most common reason for discontinuation, though progression and/or transformation accounted for a larger proportion of discontinuations in <65 and those with del(17p13). Response rates were similar for <65 and those with del(17p13). However, patients with del(17p13) had inferior PFS and OS. Ibrutinib in the front-line setting has extended beyond the population in which it was initially studied and approved. This study highlights and compares important differences in ibrutinib dosing, treatment interruptions, toxicities, reasons for discontinuation, and survival outcomes in two important patient populations not studied in RESONATE-2.
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Affiliation(s)
- Anthony R. Mato
- CLL Program, Division of Hematological Oncology; Memorial Sloan Kettering Cancer Center; New York New York
| | - Lindsey E. Roeker
- CLL Program, Division of Hematological Oncology; Memorial Sloan Kettering Cancer Center; New York New York
| | - John N. Allan
- New York Presbyterian & Weill Cornell; New York New York
| | - John M. Pagel
- Center for Blood Disorders and Stem Cell Transplantation; Swedish Cancer Institute; Seattle Western Australia
| | - Danielle M. Brander
- Division of Hematologic Malignancies and Cellular Therapy; Duke University; Durham North Carolina
| | - Brian T. Hill
- Taussig Cancer Institute; Cleveland Clinic; Cleveland Ohio
| | - Bruce D. Cheson
- Lombardi Comprehensive Cancer Center; Georgetown University Hospital; Washington District of Columbia
| | | | | | - Constantine S. Tam
- Peter McCallum Cancer Centre; University of Melbourne; East Melbourne VI Australia
| | - Sasanka Handunnetti
- Peter McCallum Cancer Centre; University of Melbourne; East Melbourne VI Australia
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders; Levine Cancer Institute, Carolinas Healthcare System; Charlotte North Carolina
| | | | - Erica Bhavsar
- New York Presbyterian & Weill Cornell; New York New York
| | - Paul M. Barr
- Wilmot Cancer Institute; University of Rochester Medical Center; Rochester New York
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Seattle Western Australia
| | - Alan P. Skarbnik
- John Theurer Cancer Center; Hackensack University Medical Center; Hackensack New Jersey
| | - Andre Goy
- John Theurer Cancer Center; Hackensack University Medical Center; Hackensack New Jersey
| | - Douglas F. Beach
- Division of Hematology and Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | - Jakub Svoboda
- Division of Hematology and Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | | | | | - Clive S. Zent
- Wilmot Cancer Institute; University of Rochester Medical Center; Rochester New York
| | | | - Stephen J. Schuster
- Division of Hematology and Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | - Peter V. Pickens
- Abington Hematology/Oncology Associates Inc.; Willow Grove Pennsylvania
| | - Nirav N. Shah
- Division of Hematology & Oncology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Joanna Rhodes
- Division of Hematology and Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | - Chaitra S. Ujjani
- Lombardi Comprehensive Cancer Center; Georgetown University Hospital; Washington District of Columbia
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40
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Mato AR, Thompson M, Allan JN, Brander DM, Pagel JM, Ujjani CS, Hill BT, Lamanna N, Lansigan F, Jacobs R, Shadman M, Skarbnik AP, Pu JJ, Barr PM, Sehgal AR, Cheson BD, Zent CS, Tuncer HH, Schuster SJ, Pickens PV, Shah NN, Goy A, Winter AM, Garcia C, Kennard K, Isaac K, Dorsey C, Gashonia LM, Singavi AK, Roeker LE, Zelenetz A, Williams A, Howlett C, Weissbrot H, Ali N, Khajavian S, Sitlinger A, Tranchito E, Rhodes J, Felsenfeld J, Bailey N, Patel B, Burns TF, Yacur M, Malhotra M, Svoboda J, Furman RR, Nabhan C. Real-world outcomes and management strategies for venetoclax-treated chronic lymphocytic leukemia patients in the United States. Haematologica 2018; 103:1511-1517. [PMID: 29880613 PMCID: PMC6119152 DOI: 10.3324/haematol.2018.193615] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/05/2018] [Indexed: 11/09/2022] Open
Abstract
Venetoclax is a BCL2 inhibitor approved for 17p-deleted relapsed/refractory chronic lymphocytic leukemia with activity following kinase inhibitors. We conducted a multicenter retrospective cohort analysis of patients with chronic lymphocytic leukemia treated with venetoclax to describe outcomes, toxicities, and treatment selection following venetoclax discontinuation. A total of 141 chronic lymphocytic leukemia patients were included (98% relapsed/refractory). Median age at venetoclax initiation was 67 years (range 37-91), median prior therapies was 3 (0-11), 81% unmutated IGHV, 45% del(17p), and 26.8% complex karyotype (≥ 3 abnormalities). Prior to venetoclax initiation, 89% received a B-cell receptor antagonist. For tumor lysis syndrome prophylaxis, 93% received allopurinol, 92% normal saline, and 45% rasburicase. Dose escalation to the maximum recommended dose of 400 mg daily was achieved in 85% of patients. Adverse events of interest included neutropenia in 47.4%, thrombocytopenia in 36%, tumor lysis syndrome in 13.4%, neutropenic fever in 11.6%, and diarrhea in 7.3%. The overall response rate to venetoclax was 72% (19.4% complete remission). With a median follow up of 7 months, median progression free survival and overall survival for the entire cohort have not been reached. To date, 41 venetoclax treated patients have discontinued therapy and 24 have received a subsequent therapy, most commonly ibrutinib. In the largest clinical experience of venetoclax-treated chronic lymphocytic leukemia patients, the majority successfully completed and maintained a maximum recommended dose. Response rates and duration of response appear comparable to clinical trial data. Venetoclax was active in patients with mutations known to confer ibrutinib resistance. Optimal sequencing of newer chronic lymphocytic leukemia therapies requires further study.
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Affiliation(s)
- Anthony R Mato
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Thompson
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Chaitra S Ujjani
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic Foundation, OH, USA
| | | | | | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | - Mazyar Shadman
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, WA, USA
| | - Alan P Skarbnik
- John Theurer Cancer Center, Hackensack Meridian Health, NJ, USA
| | | | - Paul M Barr
- Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | | | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Clive S Zent
- Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | | | - Stephen J Schuster
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Brookfield, WI, USA
| | - Andre Goy
- John Theurer Cancer Center, Hackensack Meridian Health, NJ, USA
| | | | | | - Kaitlin Kennard
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Krista Isaac
- Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Colleen Dorsey
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa M Gashonia
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Arun K Singavi
- Division of Hematology & Oncology, Medical College of Wisconsin, Brookfield, WI, USA
| | - Lindsey E Roeker
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Zelenetz
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annalynn Williams
- Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | | | | | - Naveed Ali
- Abington Hem. Onc. Assoc., Inc., Willow Grove, PA, USA
| | - Sirin Khajavian
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, WA, USA
| | - Andrea Sitlinger
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Eve Tranchito
- Taussig Cancer Institute, Cleveland Clinic Foundation, OH, USA
| | - Joanna Rhodes
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | | | | | | | | | - Jakub Svoboda
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
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41
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Wierda WG, Siddiqi T, Flinn I, Badoux XC, Kipps TJ, Allan JN, Tedeschi A, Pagel JM, Kuss BJ, González Barca E, Ghia P, Eckert K, Zhou C, Ninomoto J, Dean JP, James DF, Tam C. Phase 2 CAPTIVATE results of ibrutinib (ibr) plus venetoclax (ven) in first-line chronic lymphocytic leukemia (CLL). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7502] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Ian Flinn
- Sarah Cannon Research Institute, Nashville, TN
| | | | - Thomas J. Kipps
- University of California San Diego Moores Cancer Center, La Jolla, CA
| | - John N. Allan
- Weill Cornell Medical College, New-York Presbyterian Hospital, New York, NY
| | | | | | | | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Karl Eckert
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Joi Ninomoto
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | | | - Constantine Tam
- Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, Australia
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42
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Vaisitti T, Braggio E, Allan JN, Arruga F, Serra S, Zamò A, Tam W, Chadburn A, Furman RR, Deaglio S. Novel Richter's syndrome xenograft models to study genetic architecture, biology and therapy responses. Cancer Res 2018; 78:3413-3420. [DOI: 10.1158/0008-5472.can-17-4004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/10/2018] [Accepted: 04/26/2018] [Indexed: 11/16/2022]
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Abstract
The emergence of targeted therapy for patients with chronic lymphocytic leukemia (CLL) has permanently altered the therapeutic landscape. In both upfront and relapsed settings, safe and effective oral kinase inhibitors are available which rival the responses and durability seen with standard chemo immunotherapy regimens. In 2016, ibrutinib was granted Federal Drug Administration approval for first-line therapy in patients with CLL. While its role as initial therapy for older, unfit or deleted 17p CLL patients is less controversial, its role as first-line treatment for younger fit patients is less clear, begging the question, what is the optimal treatment for these patients, novel agents or standard CIT strategies? In this review, we aim to provide guidance for what we believe is the optimal management of young fit patients with CLL.
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Affiliation(s)
- John N Allan
- Weill Cornell Medicine, Division of Hematology and Medical Oncology, CLL Research Center, 1305 York Ave, New York, NY, 10021, USA.
| | - Richard R Furman
- Weill Cornell Medicine, Division of Hematology and Medical Oncology, CLL Research Center, 1305 York Ave, New York, NY, 10021, USA
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44
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Affiliation(s)
| | - Emily Newsom
- Department of Dermatology, Weill Cornell/New York Presbyterian, New York, New York
| | - Erica H. Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John N. Allan
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell/New York Presbyterian, New York, New York
| | - Kira Minkis
- Department of Dermatology, Weill Cornell/New York Presbyterian, New York, New York
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45
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Vaisitti T, Gaudino F, Ouk S, Moscvin M, Vitale N, Serra S, Arruga F, Zakrzewski JL, Liou HC, Allan JN, Furman RR, Deaglio S. Targeting metabolism and survival in chronic lymphocytic leukemia and Richter syndrome cells by a novel NF-κB inhibitor. Haematologica 2017; 102:1878-1889. [PMID: 28860341 PMCID: PMC5664392 DOI: 10.3324/haematol.2017.173419] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/28/2017] [Indexed: 02/04/2023] Open
Abstract
IT-901 is a novel and selective NF-κB inhibitor with promising activity in pre-clinical models. Here we show that treatment of chronic lymphocytic leukemia cells (CLL) with IT-901 effectively interrupts NF-κB transcriptional activity. CLL cells exposed to the drug display elevated mitochondrial reactive oxygen species, which damage mitochondria, limit oxidative phosphorylation and ATP production, and activate intrinsic apoptosis. Inhibition of NF-κB signaling in stromal and myeloid cells, both tumor-supportive elements, fails to induce apoptosis, but impairs NF-κB-driven expression of molecules involved in cell-cell contacts and immune responses, essential elements in creating a pro-leukemic niche. The consequence is that accessory cells do not protect CLL cells from IT-901-induced apoptosis. In this context, IT-901 shows synergistic activity with ibrutinib, arguing in favor of combination strategies. IT-901 is also effective in primary cells from patients with Richter syndrome (RS). Its anti-tumor properties are confirmed in xenograft models of CLL and in RS patient-derived xenografts, with documented NF-κB inhibition and significant reduction of tumor burden. Together, these results provide pre-clinical proof of principle for IT-901 as a potential new drug in CLL and RS.
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Affiliation(s)
- Tiziana Vaisitti
- Department of Medical Sciences, University of Turin, Italy .,Italian Institute for Genomic Medicine, Turin, Italy
| | - Federica Gaudino
- Department of Medical Sciences, University of Turin, Italy.,Italian Institute for Genomic Medicine, Turin, Italy
| | | | - Maria Moscvin
- Italian Institute for Genomic Medicine, Turin, Italy
| | - Nicoletta Vitale
- Department of Molecular Biotechnologies and Health Sciences, University of Turin, Italy
| | - Sara Serra
- Department of Medical Sciences, University of Turin, Italy.,Italian Institute for Genomic Medicine, Turin, Italy
| | | | | | | | - John N Allan
- CLL Research Center, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Richard R Furman
- CLL Research Center, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Silvia Deaglio
- Department of Medical Sciences, University of Turin, Italy .,Italian Institute for Genomic Medicine, Turin, Italy
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46
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Allan JN, Roboz GJ, Askin G, Ritchie E, Scandura J, Christos P, Hassane DC, Guzman ML. CD25 expression and outcomes in older patients with acute myelogenous leukemia treated with plerixafor and decitabine. Leuk Lymphoma 2017; 59:821-828. [PMID: 28718760 DOI: 10.1080/10428194.2017.1352089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We investigated CD25 expression in older (≥60 years) patients with new acute myelogenous leukemia treated with decitabine and plerixafor. Patients resistant to therapy or survival ≤1 year had significantly higher percentages of CD25pos myeloid blasts in baseline bone marrow. CD25pos patients had an increased odds of resistance compared to CD25neg patients (p = .015). In univariate analysis, we found CD25pos patients had inferior survival compared to CD25neg (p = .002). In patients with intermediate risk cytogenetics, CD25pos status stratified patients associating with inferior survival (p = .002). In multivariable analysis, CD25 and TP53 mutations trended towards predicting remission to therapy but were not predictive of survival. Only remission status, ASXL1 and TET2 mutations were found to independently predict overall survival (OS). We conclude CD25 expression identifies patients at risk for resistance to hypomethylating chemotherapy but does not independently predict OS in an older AML population treated with decitabine and plerixafor.
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Affiliation(s)
- John N Allan
- a Department of Medicine, Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
| | - Gail J Roboz
- a Department of Medicine, Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
| | - Gulce Askin
- b Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology , Weill Cornell Medicine , New York , NY , USA
| | - Ellen Ritchie
- a Department of Medicine, Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
| | - Joseph Scandura
- a Department of Medicine, Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
| | - Paul Christos
- b Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology , Weill Cornell Medicine , New York , NY , USA
| | - Duane C Hassane
- a Department of Medicine, Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
| | - Monica L Guzman
- a Department of Medicine, Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
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47
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Furman RR, Allan JN, Howes AJ, Mahler M, Wildgust MA. Comparing overall survival (OS) outcomes in patients with newly diagnosed chronic lymphocytic leukemia (CLL) with normal life expectancy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7 Background: CLL is an orphan hematologic malignancy but also accounts for the most common adult leukemia in the Western Hemisphere, with a median age at diagnosis of 72 years. Median OS for symptomatic, treatment-naïve, elderly patients with CLL is approximately 5.3 years (CLL5; Eichhorst, et al. Blood 2009), whereas the life expectancy of a 72 year old (yo) is around 12 years (US Life Tables, 2006). Ibrutinib, an oral, first-in-class, covalent Bruton’s tyrosine kinase inhibitor, significantly improves OS. Early results from a phase 1/2 study in treatment-naïve elderly patients with CLL (PCYC-1102; median age, 71 years) suggest that single-agent ibrutinib extends OS, with survival at 3 years of approximately 97% (Byrd, et al. Blood 2015). Here we compare the OS in newly diagnosed patients with CLL treated with single-agent ibrutinib or chlorambucil with the normal life expectancy of a 72 yo adult. Methods: OS outcomes for patients treated with chlorambucil from the CLL5 study conducted in Germany (Eichhorst, et al. Blood 2009) were compared with long-term OS results from PCYC-1102 (Byrd, et al. Blood 2015). Life expectancy data were obtained from US Life Tables. Results: Results from CLL5 suggest that single-agent chlorambucil has a median OS of 5.3 years (median age, 71 years), with approximately 75% of patients alive at 3 years. The median OS for ibrutinib has not been reached (median follow-up, 3 years), with an estimated progression-free survival of 96% and OS of 97% at 3 years. Life expectancy for a 72 yo healthy person at 3 years is approximately 95%. Naïve comparisons suggest that single-agent ibrutinib may be altering the natural history of CLL, providing a longer OS versus chlorambucil and a similar OS as expected in a 72 yo in the general population. Conclusions: Treatment outcomes in CLL are fundamentally changing with the advent of new targeted therapies. This indirect naïve comparison between ibrutinib-treated patients and a general population suggests we may be moving from palliative care for elderly patients with CLL to chronic care management. Implications for chronic care management of patients with CLL will be discussed.
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Affiliation(s)
- Richard R. Furman
- Weill Cornell Medical College, New-York Presbyterian Hospital, New York, NY
| | - John N Allan
- Weill Cornell Medical College, New-York Presbyterian Hospital, New York, NY
| | - Angela J. Howes
- Janssen Research and Development, High Wycombe, United Kingdom
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Abstract
Despite increased comprehension of acute myelogenous leukemia (AML) pathogenesis, current treatment strategies have done little to improve upon standard induction chemotherapy to induce long-term remissions. Since the identification of the leukemic stem cell, efforts have been placed on identifying therapeutically actionable pathways that distinguish this increasingly important cellular compartment. With the advent of increased genome sequencing efforts and phenotypic characterization, opportunities for personalized treatment strategies are rapidly emerging. In this review, we highlight recent advances in the understanding of leukemic stem cell biology and their potential for translation into clinically relevant therapeutics. NF-kappa B activation, Bcl-2 expression, oxidative and metabolic state, and epigenetic modifications all bear their own clinical implications. With advancements in genetic, epigenetic, and metabolic profiling, personalized strategies may be feasible in the near future to improve outcomes for AML patients.
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Affiliation(s)
- Monica L Guzman
- Division of Hematology/Medical Oncology, Department of Medicine, Weill Medical College of Cornell University, New York, New York, USA
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49
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Allan JN, Friedman KD, DeSancho MT. Life-threatening bleeding in a patient with mild hemophilia A and heterozygosity for von Willebrand disease Type 2N. Int J Hematol 2014; 100:602-6. [PMID: 25212677 DOI: 10.1007/s12185-014-1662-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 08/29/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022]
Abstract
Hemophilia A and von Willebrand disease (VWD) are distinct bleeding disorders with a spectrum of clinical phenotypes. They are characterized by mutations in either factor VIII (F8) or von Willebrand factor (VWF) genes, respectively. The pattern of inheritance and appropriate laboratory evaluation differentiates these diseases, and treatment strategies for both are different. Here, we report a male patient with hemophilia A and VWD Type 2 Normandy (N) mutations who presented with life-threatening bleeding. We document his medical history, clinical course, management, and diagnostic work up.
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Affiliation(s)
- John N Allan
- Division of Hematology Oncology, Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street 3rd Floor Starr Pavilion, New York, NY, 10065, USA,
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