PracticeUpdate: Oncology - Winter 2018

CONFERENCE COVERAGE 30

23rd Congress of The European Hematology Association 14–17 JUNE 2018 • STOCKHOLM, SWEDEN By the PracticeUpdate Editorial Team

© EHA 2018

Consider Obinutuzumab Plus Chlorambucil for First-Line Treatment for CLL Obinutuzumab plus chlorambucil provide clinically meaningful benefits in CLL patients with comorbidities A combination of obinutuzumab plus chlorambucil (G-Clb) should be considered a first-line treatment for chronic lymphocytic leukemia (CLL) patients with comorbidities. developing stem cell in the bone marrow is damaged. Because CLL does not com- pletely interfere with the growth of mature red cells, white cells, and platelets, it is gen-

Patients were randomized 1:2:2 to receive six 28-day cycles (C) of Clb, R-Clb or G-Clb. The dosing schedule was as follows: Clb (0.5 mg/kg) was administered orally on Day 1 and D15 of C1–6. R was administered intravenously (IV) at a dose of 375 mg/m 2 on D1 of C1 and 500 mg/m 2 on D1 of C2–6. Obinutuzumab (1000 mg) was administered IV on D1 (dose split over two days; 100 mg D1, 900 mg D2), D8 and D15 of C1, and D1 of C2–6. A total of 781 patients were enrolled and received treatment (median: age, 73 years; CIRS score, 8; CrCl, 62 mL/min). Eligible patients had previously untreated CD20+ CLL, a total cumulative illness rating scale (CIRS) score of >6 and/or a creatinine clear- ance (CrCl) of <70 mL/min. “The primary endpoint was investigator-assessed pro- gression-free survival,” the investigators noted in their abstract. Secondary end- points included overall survival, time to new treatment and safety.

erally less severe than acute leukemia. A slower-growing form of CLL produces an increased number of lymphocytes, but a normal or slightly below normal level of red cells, platelets, and neutrophils in the blood. This form of the disease can remain stable for years. The faster-growing form of CLL, however, has too many cells in the blood that block normal cell production. As a result, the number of fully functioning red cells and platelet levels drop below normal. This phase III study conducted by Goede et al evaluated the efficacy and safety of obinutuzumab, a glycoengineered type II anti-CD20monoclonal antibody developed as an effective treatment for CLL, in combi- nation with chlorambucil (Clb) and rituximab (R) plus Clb (R-Clb) vs Clb alone (Stage 1). As well the use of G-Clb was compared to R-Clb (Stage 2) in patients with previously untreated CLL and comorbidities.

The investigators, led by Valentin Goede, MD, a hematologist/oncologist in the Department of Internal Medicine with the University Hospital of Cologne in Germany, presented the findings from the final analy- sis of the CLL11 study. The research team suggested that obinutuzumab should be the preferred anti-CD20 antibody in future combination regimens for CLL. In their abstract, Overall Survival Benefit of Obinutuzumab Over Rituximab When Combined With Chlorambucil in Patients With Chronic Lymphocytic Leukemia and Comorbidities: Final Survival Analysis of the Cll11 Study , the research team stated that G-Clb yields clinically meaningful ben- efits in CLL patients with comorbidities. CLL, the most common form of leukemia in adults, occurs when the DNA of a

PRACTICEUPDATE ONCOLOGY