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VIDEO: Trials explore optimal treatments, resistance in chronic lymphocytic leukemia

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SAN DIEGO — In this video, HemOnc Today Editorial Board member John C. Byrd, MD, discusses two late-breaking abstracts presented at the ASH Annual Meeting and Exposition that have clinical implications for the treatment of chronic lymphocytic leukemia.

Byrd, who is also Distinguished University Professor and D. Warren Brown Chair of Leukemia Research at the Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, first discusses a phase 3 trial that compared ibrutinib (Imbruvica; Pharmacyclics, Janssen) plus rituximab (Rituxan; Genentech, Biogen) with standard chemoimmunotherapy among previously untreated younger patients.

After median follow-up of 33.4 months, researchers found the ibrutinib-based regimen significantly improved the primary endpoint of PFS over the chemoimmunotherapy combination.

“Many of us in the field were quite surprised that even with such a short follow-up, there also was a very significant improvement in OS with ibrutinib and rituximab,” Byrd says.

The second late-breaking abstract Byrd discusses is about a recurrent mutation in the BCL2 protein that confers resistance to venetoclax (Venclexta; AbbVie, Genentech). The mutation, known as Gly101Val, was detected in seven patients with progressive CLL who did not harbor the mutation prior to venetoclax treatment.

“This is a very early finding,” Byrd says. “The importance of it, however, if the finding is true, is that the authors identified this mutation present at low variant allele frequencies before patients actually clinically relapsed. This would set up the potential that one could look for mutations that predict resistance before resistance develops and direct patients toward alternative therapies vs. letting them fully relapse.”

References:

Blombery, et al. Abstract LBA-7. Presented at: ASH Annual Meeting and Exposition; Dec. 1-4, 2018; San Diego.

Shanafelt TD, et al. Abstract LBA-4. Presented at: ASH Annual Meeting and Exposition; Dec. 1-4, 2018; San Diego.

Disclosure: Byrd reports participating in clinical trials for AbbVie and Pharmacyclics.