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Time-Limited Targeted Therapy Versus Chemoimmunotherapy in CLL

By: Kayci Reyer
Posted: Tuesday, July 12, 2022

Targeted therapy may result in longer progression-free survival versus chemoimmunotherapy in patients with treatment-naive chronic lymphocytic leukemia (CLL), according to findings presented at the European Hematological Association (EHA) 2022 Congress (Abstract LB2365). Barbara Eichhorst, MD, of the University of Cologne, Germany, and colleagues assessed the efficacy of three time-bound first-line venetoclax treatment regimens versus chemoimmunotherapy, the current standard of care, in this patient population.

The phase III CAIA/CLL13 trial included 926 patients, with a median age of 61 years, none of whom harbored a TP53 aberration. Patients were randomly assigned to receive chemoimmunotherapy (n = 229), venetoclax plus rituximab (n = 237), venetoclax plus obinutuzumab (n = 229), or venetoclax plus obinutuzumab plus ibrutinib (n = 231). A total of 73.5% of patients had a Binet stage of B or C, and 56% had an unmutated IGHV status.

At a median observation of 38.8 months, the 3-year progression-free survival was longer with venetoclax/obinutuzumab (87.7%) and (90.5%) than with chemoimmunotherapy (75.5%). However, progression-free survival was comparable between the venetoclax/rituximab (80.8%) and chemoimmunotherapy arms. Patients with mutated IGHV status experienced superior 3-year progression-free survival versus those with unmutated IGHV status regardless of the type of treatment. Overall survival was similar across treatment arms.

Hematologic adverse events were also similar across arms. Grade 3 or 4 adverse events occurred more often among patients receiving triplet therapy (21.2%) or chemoimmunotherapy (18.5%) than among those receiving venetoclax/obinutuzumab (13.2%) or venetoclax/rituximab (10.5%) therapies. Secondary neoplasia was most common for patients receiving chemoimmunotherapy (n = 36). All arms experienced similar rates of fatal adverse events. The chemoimmunotherapy, venetoclax/rituximab, venetoclax/obinutuzumab, and triple-therapy arms comprised 10, 8, 9, and 9 deaths, respectively.

Disclosure: For full disclosures of the study authors, visit library.ehaweb.org.


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