Tillkännagivande • 1h
AbbVie Announces European Commission Authorization of Expanded Label for VENCLYXTO (venetoclax) to Include Additional Combinations in Previously Untreated Chronic Lymphocytic Leukemia
AbbVie announced that the European Commission has authorized an expanded label for VENCLYXTO (venetoclax) to include use in combination with acalabrutinib (with or without obinutuzumab) and use in combination with ibrutinib for the treatment of adult patients with previously untreated chronic lymphocytic leukemia (CLL). The expanded label follows the European Commission's inclusion of these combinations in the acalabrutinib and ibrutinib labels. These all-oral, fixed-duration combination regimens support current standards of care and offer patients and providers additional targeted oral medications for CLL in the first-line setting that include the potential for time off treatment. The European Commission authorization extends to all European Union Member States, as well as Iceland, Norway and Liechtenstein. VENCLYXTO in combination with acalabrutinib (with or without obinutuzumab) was supported by data from the Phase 3 AMPLIFY trial. VENCLYXTO in combination with ibrutinib was supported by data from the Phase 3 GLOW and Phase 2 CAPTIVATE trials. VENCLYXTO-based combination regimens have demonstrated a favorable efficacy and safety profile in the first-line setting for chronic lymphocytic leukemia. VENCLYXTO in combination with acalabrutinib (with or without obinutuzumab) was supported by data from the Phase 3 AMPLIFY trial. VENCLYXTO in combination with ibrutinib was supported by data from the Phase 3 GLOW and Phase 2 CAPTIVATE trials. The AMPLIFY (NCT03836261) study is a randomized, global, multicenter, open-label Phase 3 trial evaluating the efficacy and safety of the fixed-duration combination regimen of VENCLYXTO and acalabrutinib, with or without obinutuzumab, compared to chemoimmunotherapy in adult patients with previously untreated CLL without del (17p) or TP53 mutation. Results showed that the fixed-duration combination regimen of VENCLYXTO and acalabrutinib was superior to chemoimmunotherapy. Study results showed the combination regimen reduced the risk of disease progression or death by 35% versus chemoimmunotherapy. Median progression-free survival (PFS) was not reached versus 47.6 months for chemoimmunotherapy. The triplet regimen including obinutuzumab also demonstrated clinically meaningful efficacy, with median PFS likewise not reached. The safety profiles of the combination regimens were consistent with the known safety profiles of each individual therapy alone. No new safety signals were observed in the AMPLIFY study. The most common adverse reactions (=15%) of any grade in patients who received VENCLYXTO and acalabrutinib were headache (35%), diarrhea (33%), musculoskeletal pain (25%), COVID-19 (21%), fatigue (18%), bruising (17%), rash (16%), and nausea (15%). The most common laboratory abnormalities (=15%) of any grade were neutrophils decreased (78%), glucose increased (74%), lymphocytes decreased (56%), platelets decreased (43%), hemoglobin decreased (35%), calcium decreased (30%), ALT increased (26%), urate increased (25%), LDH increased (24%), potassium increased (22%), AST increased (22%), ALP increased (20%), glucose decreased (20%), creatinine increased (19%), and sodium increased (15%). Grade 4 laboratory abnormalities in >15% of patients included absolute neutrophil count decreased (15%). Serious adverse reactions occurred in 25% of patients receiving VENCLYXTO and acalabrutinib. The most common serious adverse reactions (=2%) were COVID-19, including COVID-19 pneumonia (9%), second primary malignancies (2.7%) and neutropenia (2.1%). Fatal adverse events occurred in 3.4% of patients. The most common fatal adverse events included COVID-19 and COVID-19 pneumonia. The GLOW (NCT03462719) study is a randomized, open-label Phase 3 trial comparing progression-free survival in patients treated with the fixed-duration combination regimen of VENCLYXTO and ibrutinib or chlorambucil plus obinutuzumab in adult patients with previously untreated CLL. Results from the 64-month follow-up to the GLOW study showed that the fixed-duration combination regimen of VENCLYXTO and ibrutinib demonstrated a clinically meaningful improvement in PFS and overall survival (OS) compared to chlorambucil plus obinutuzumab for older patients and/or those with comorbidities with previously untreated CLL. At 64 months of follow-up, VENCLYXTO and ibrutinib reduced the risk of disease progression or death by 73% compared to chlorambucil plus obinutuzumab. For OS, the regimen reduced the risk of death by 54%. Study results showed a median PFS of 65 months in the venetoclax plus ibrutinib arm versus 23 months in the chlorambucil plus obinutuzumab arm. The safety profile of VENCLYXTO and ibrutinib was generally consistent with the safety profile of the single agents and tolerability profiles were consistent with CLL treatment in the enrolled patient population. Most common grade =3 treatment-emergent adverse events (AEs) were neutropenia (34.9%), infections (17%), and diarrhea (10.4%) for VENCLYXTO and ibrutinib; neutropenia (49.5%), infections (11.4%), and thrombocytopenia (20%) for chlorambucil plus obinutuzumab. Deaths during treatment occurred in seven patients on VENCLYXTO and ibrutinib and two patients on chlorambucil plus obinutuzumab. The VENCLYXTO and ibrutinib regimen was well-tolerated and no adverse events of tumor lysis syndrome (TLS) were observed in the venetoclax plus ibrutinib arm, compared to 6 cases in the chlorambucil with obinutuzumab arm. At 64-months follow-up, the time patients spent without significant toxicity or disease progression was significantly longer for VENCLYXTO and ibrutinib versus chlorambucil plus obinutuzumab (52 months vs 31 months). Treatment-emergent adverse event-free PFS (TEAE-free PFS) analysis showed that while patients receiving 15 months of VENCLYXTO and ibrutinib spent slightly more time in the grade 3/4 toxicity state versus patients receiving 6 months of chlorambucil plus obinutuzumab (2 months vs 1 month), patients who received VENCLYXTO and ibrutinib spent substantially more time in TEAE-free PFS (50 months vs 30 months), indicating longer disease control without significant toxicity. The CAPTIVATE (NCT02910583) study is a multicenter, two-cohort Phase 2 trial assessing both minimal residual disease (MRD)-guided discontinuation and fixed duration therapy with the combination of VENCLYXTO plus ibrutinib in adult patients with previously untreated CLL or small lymphocytic lymphoma (SLL). Results showed that the fixed-duration combination regimen of VENCLYXTO plus ibrutinib demonstrated 5.5-year PFS and overall survival (OS) rates of 66% and 97%, respectively; 73% of CLL patients remained treatment-free 5.5 years after 15 months of VENCLYXTO plus ibrutinib therapy. The most common treatment-emergent AEs in patients who received VENCLYXTO plus ibrutinib were diarrhea (62%), nausea (43%), neutropenia (42%) and arthralgia (33%); AEs were primarily grade 1 or 2 in severity.