Advertisement


Mazyar Shadman, MD, MPH, on Chronic Lymphocytic Leukemia: Update on BTK Inhibitors

2024 ASCO Annual Meeting

Advertisement

Mazyar Shadman, MD, MPH, of Fred Hutchinson Cancer Center, discusses a network meta-analysis showing that zanubrutinib appears to be the most efficacious Bruton’s tyrosine kinase (BTK) inhibitor for patients with high-risk relapsed or refractory chronic lymphocytic leukemia. It offers delayed disease progression and favorable survival and response, compared with alternative BTK inhibitors (Abstract 7048).

 



Transcript

Disclaimer: This video transcript has not been proofread or edited and may contain errors.
At the ASCO meeting, we presented data on Network meta-analysis comparing the efficacy of covalent BTK inhibitors for treatment of relapsed refractory CLL. As the background, there are three covalent BTK inhibitors currently approved for CLL, and we do have some randomized trials comparing some of these drugs. For example, acalabrutinib was compared to ibrutinib in the relapse setting in Elevate RR study, and zanubrutinib was compared to ibrutinib in the Alpine trial. However, we don't have a comparison between the two second-generation covalent BTK inhibitors, zanubrutinib and acalabrutinib. There has been an effort recently to indirectly compare the efficacy of this drug through methods like matching adjusted indirect comparison or MAIC. Here we are using another methodology for this indirect comparison called Network meta-analysis, and this is a technique that gives us the opportunity of comparing multiple interventions and use both direct and indirect comparisons. So here we use three clinical trials after going through the inclusion criteria for different trials, and we used Alpine, which compared zanubrutinib versus ibrutinib. We used Elevate RR, which compared acalabrutinib versus ibrutinib, and we also used Ascend trial which compared acalabrutinib versus chemotherapy. And the findings were summarized and in brief, when we looked at the overall response, zanubrutinib was superior to ibrutinib in terms of overall response, the CR rate was not as statistically significant. Also in terms of the overall response and CR rate comparison between zanubrutinib and ibrutinib while there was a trend in favor of zanubrutinib this was not as statistically significant. We also looked at progression free survival, and we did it by adjusting for COVID-19 and also presented the unadjusted comparison. So in the high risk population defined by each clinical trial, zanubrutinib was found to be superior to both ibrutinib and acalabrutinib and also chemo immunotherapy through this PFS analysis. And that was true whether or not we adjusted for COVID-19 or not. When we limited the analysis to only patients with del(17p), zanubrutinib remained superior to ibrutinib and chemo immunotherapy. And also zanubrutinib in the adjusted analysis, but on the unadjusted analysis there was no statistically difference between zanubrutinib and acalabrutinib. And we also looked at overall survival. And while there was a trend in favor of zanubrutinib, this was not a statistically significant. So overall, this is an important study in providing another piece of data and evidence for both clinicians and investigators to put it next to the other analysis that we have recently done and others have done. I would like to remind ourselves that the gold standard remains to be randomized to have clinical trials, and in the absence of direct comparison, we can use methods like MAIC or MET Network meta-analysis to give us a better understanding of the efficacy.

Related Videos

Leukemia
Lymphoma

Muhit Özcan, MD, on CLL/SLL: Report on a Still-Recruiting International Study of Nemtabrutinib, Venetoclax, and Rituximab

Muhit Özcan, MD, of Turkey’s Ankara University School of Medicine, discusses the ongoing phase III BELLWAVE-010 study of nemtabrutinib plus venetoclax vs venetoclax plus rituximab in previously treated patients with relapsed or refractory chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) (Abstract TPS7089).  

Lymphoma

Yasmin H. Karimi, MD, on Diffuse Large B-Cell Lymphoma: Update on Use of Epcoritamab Plus Chemotherapy

Yasmin H. Karimi, MD, of the University of Michigan Comprehensive Cancer Center, discusses data reaffirming the efficacy and feasibility of using epcoritamab plus R-DHAX/C (rituximab, dexamethasone, cytarabine, and oxaliplatin or carboplatin) in autologous stem cell transplant–eligible patients with diffuse large B-cell lymphoma. Response rates were reported to be high, and most patients proceeded to transplant (Abstract 7032).

Breast Cancer

Pierfranco Conte, MD, on Early-Stage Triple-Negative Breast Cancer: Trial Update on Avelumab as Adjuvant Treatment

Pierfranco Conte, MD, of the University of Padua, discusses phase III findings from the A-BRAVE trial, which was designed to evaluate the efficacy of avelumab, an anti–PD-L1 antibody, as adjuvant treatment for patients with early-stage triple-negative breast cancer who are at high risk (LBA500).

Palliative Care

Joseph A. Greer, PhD, on Lung Cancer: Telehealth vs In-Person Palliative Care

Joseph A. Greer, PhD, of Massachusetts General Hospital and Harvard Medical School, discusses study findings showing the merits of delivering early palliative care via telehealth vs in person to patients with advanced lung cancer. Using telemedicine in this way may potentially improve access to and more broadly disseminate this evidence-based care model (LBA3).

Multiple Myeloma

Thierry Facon, MD, on Multiple Myeloma: Results From the IMROZ Study on Isatuximab, Bortezomib, Lenalidomide, and Dexamethasone

Thierry Facon, MD, of the University of Lille and Lille University Hospital, discusses phase III findings showing for the first time that isatuximab, an anti-CD38 monoclonal antibody, when given with the standard of care (bortezomib, lenalidomide, dexamethasone, or VRd) to patients with newly diagnosed multiple myeloma who are transplant-ineligible, may reduce the risk of disease progression or death by 40.4% vs VRd alone (Abstract 7500).

Advertisement

Advertisement




Advertisement