Skip to content

A Study in Previously Untreated Chronic Lymphocytic Leukemia (CLL) Subjects, Excluding Those With the 17p Deletion, to Evaluate Debulking Regimens Prior to Initiating Venetoclax Combination Therapy

A Phase 3b Study in Previously Untreated Chronic Lymphocytic Leukemia (CLL) Subjects, Excluding Those With the 17p Deletion, to Evaluate Debulking Regimens Prior to Initiating Venetoclax Combination Therapy

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03406156
Enrollment
120
Registered
2018-01-23
Start date
2018-08-10
Completion date
2023-07-12
Last updated
2024-08-06

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Chronic Lymphocytic Leukemia (CLL), Small Lymphocytic Lymphoma (SLL)

Keywords

Cancer, Chronic Lymphocytic Leukemia, 17p Deletion, Debulking, Obinutuzumab, Bendamustine, Tumor lysis syndrome, Venetoclax, Small Lymphocytic Lymphoma

Brief summary

This is a multi-cohort, open-label study in previously untreated participants with chronic lymphocytic leukemia (CLL)/ small lymphocytic lymphoma (SLL), excluding those with the 17p deletion, to evaluate a debulking strategy that would enable all participants to receive subsequent venetoclax as outpatients, with lower risk of tumor lysis syndrome.

Detailed description

Safety and efficacy data through 13 October 2021 are included in the interim analysis, which was conducted after all participants completed the post-treatment Week 65 visit or discontinued from the study.

Interventions

DRUGObinutuzumab

Administered via intravenous infusion

DRUGBendamustine

Administered via intravenous infusion

DRUGVenetoclax

The venetoclax dose was administered according to a weekly ramp-up schedule over 5 weeks to the recommended daily dose of 400 mg. Venetoclax was continued for a total duration of up to 53 weeks, including the 5-week ramp-up schedule. Participants were instructed to take venetoclax tablets with a meal and water at approximately the same time each day. Venetoclax tablets were to be swallowed whole and not chewed, crushed, or broken prior to swallowing.

Sponsors

AbbVie
Lead SponsorINDUSTRY

Study design

Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No

Inclusion criteria

* Adequate hematology, kidney and liver function as described in the protocol * Diagnosis of previously untreated chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) according to 2008 Modified International Workshop on Chronic Lymphocytic Leukemia National Cancer Institute-sponsored Working Group (IWCLL NCI-WG) criteria * Eastern Cooperative Oncology Group (ECOG) performance score of 0 - 1 * CLL/SLL requires treatment according to the IWCLL criteria * Medium tumor burden (any lymph node \[LN\] 5 to \< 10 cm OR absolute lymphocyte count \[ALC\] ≥ 25 × 10\^9/L) OR High tumor burden (any LN ≥ 10 cm OR ALC ≥ 25 × 10\^9/L and LN ≥ 5 cm)

Exclusion criteria

* Presence of 17p deletion at Screening * Richter's syndrome (transformation of CLL/SLL to aggressive non-Hodgkin's lymphoma or Hodgkin's lymphoma) * Prolymphocytic leukemia

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period)From Baseline to the end of Cycles 2, 4, and 6, up to approximately 24 weeks after initial dose of study drugLow tumor burden is defined as absolute lymphocyte count (ALC) \< 25 × 10\^9 /L and all lymph nodes \< 5 cm per computed tomography (CT) scans.
Complete Remission RateFrom first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 daysComplete remission rate is defined as the percentage of participants achieving complete remission (CR) or complete remission with incomplete marrow recovery (CRi) as their best response based on 2008 Modified International Workshop for Chronic Lymphocytic Leukemia National Cancer Institute-Working Group (IWCLL NCI-WG) criteria. CR required all of the following: * Peripheral blood lymphocytes \<4000/μL * Absence of lymphadenopathy by physical examination and computed tomography scan * No hepatomegaly or splenomegaly * Absence of disease or constitutional symptoms (unexplained fevers \>38°C, drenching night sweats, ≥10% weight loss in last 6 months) * Blood counts above the following: * Neutrophils \>1500/μL * Platelets \>100,000/μL * Hemoglobin \>11.0 g/dL * Bone marrow at least normocellular for age, \<30% lymphocytes CRi was defined as participants with CR who had persistent cytopenia unrelated to CLL but related to drug toxicity.

Secondary

MeasureTime frameDescription
Progression-Free Survival (PFS)From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 daysPFS is defined as the number of days from the date of first dose of any study drug (either venetoclax, obinutuzumab, or bendamustine) to the date of disease progression or death, whichever occurs first. All disease progression was to be included regardless whether the event occurred during or after the participant was taking any study drug. Progression-free survival was analyzed by Kaplan-Meier methodology.
Time to Progression (TTP)From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 daysTTP is defined as the number of days from the date of first dose of any study drug (either venetoclax, obinutuzumab, or bendamustine) to date of disease progression. All disease progression was to be included regardless of whether the event occurred during or after the participant was taking any study drug.The distribution of the time to progression was estimated using Kaplan-Meier methodology.
Overall Response Rate (ORR)From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 daysORR is defined as the percentage of participants who achieved a best response of complete remission (CR), complete remission with incomplete marrow recovery (CRi), nodular partial remission (nPR), or partial remission (PR) based on the 2008 Modified IWCLL NCI-WG criteria at any time during the study as assessed by investigator up through the completion of the 65-week disease response assessment after the start of venetoclax. Participants who did not respond were considered non-responders.
Undetectable Minimal Residual Disease (UMRD) RateFrom first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021)The level of MRD was assessed in the peripheral blood of all participants at 5 months after last dose of obinutuzumab, and at 3 months after last dose of venetoclax/end of treatment (including early study termination) to determine the rate of UMRD. Undetectable Minimal Residual Disease is defined as less than one CLL cell per 10,000 leukocytes (\< 10\^-4 ).
Overall Survival (OS)From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 daysOS is defined as number of days from the date of first dose of any study drug (either venetoclax, obinutuzumab, or bendamustine) to the date of death. If a participant had not died, their data was censored at the date when they were last known to be alive prior to the cutoff date.The distribution of OS was estimated using Kaplan-Meier methodology.
Duration of Response (DoR)From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 daysDoR is defined as the number of days from the date of first response (CR, CRi, nPR, or PR per the 2008 Modified IWCLL NCI-WG criteria) to the date of disease progression or death, whichever occurs first. All disease progression was to be included regardless whether the event occurred during or after the participant was taking any study drug (either venetoclax, obinutuzumab, or bendamustine). Duration of response was analyzed by Kaplan-Meier (K-M) methodology.

Countries

United States

Participant flow

Pre-assignment details

All Treated Participants: all enrolled participants who received at least one dose of any study drug

Participants by arm

ArmCount
Obinutuzumab
Obinutuzumab (100 mg on Day 1 of Cycle 1, 900 mg on Day 2 of Cycle 1, and 1000 mg on Days 8 and 15 of Cycle 1 and Day 1 of Cycle 2; for Cycles 3 - 6 (1000 mg on Day 1) only as needed for participants to achieve low tumor burden) was administered via intravenous infusion during the debulking regimen. After debulking, obinutuzumab (1000 mg) was administered via intravenous infusion on Day 1 of one 5-week and four 4-week cycles during the obinutuzumab/venetoclax combination part of the regimen. Venetoclax was administered according to a weekly ramp-up schedule over 5 weeks to the recommended daily dose of 400 mg.
84
Obinutuzumab/Bendamustine
Obinutuzumab (100 mg on Day 1 of Cycle 1, 900 mg on Day 2 of Cycle 1, and 1000 mg on Days 8 and 15 of Cycle 1 and Day 1 of Cycle 2; for Cycles 3 - 6 (1000 mg on Day 1) only as needed for participants to achieve low tumor burden) was administered via intravenous infusion during the debulking regimen. Bendamustine (90 mg/m\^2 ) was to be administered to those with nodes or nodal mass \> 10 cm, or with del(11q) and \> 5 cm nodes, or at the discretion of the investigator as above, via intravenous infusion over 10 minutes on Days 1 and 2 (or Days 2 and 3 at the discretion of the investigator during Cycle 1) of each 28-day cycle for up to 6 cycles during the debulking regimen. After debulking, obinutuzumab (1000 mg) was administered via intravenous infusion on Day 1 of one 5-week and four 4-week cycles during the obinutuzumab/venetoclax combination part of the regimen. Venetoclax was administered according to a weekly ramp-up schedule over 5 weeks to the recommended daily dose of 400 mg.
36
Total120

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyCOVID-19 infection10
Overall StudyDeath93
Overall StudyLost to Follow-up02
Overall StudyNon-compliance with study procedures11
Overall StudyOther, not specified7228
Overall StudyWithdrawal by Subject12

Baseline characteristics

CharacteristicObinutuzumabObinutuzumab/BendamustineTotal
Age, Continuous64.5 years
STANDARD_DEVIATION 10.06
60.7 years
STANDARD_DEVIATION 9.07
63.4 years
STANDARD_DEVIATION 9.9
Race/Ethnicity, Customized
American Indian/Alaska Native
0 Participants0 Participants0 Participants
Race/Ethnicity, Customized
Asian
0 Participants0 Participants0 Participants
Race/Ethnicity, Customized
Black or African American
5 Participants2 Participants7 Participants
Race/Ethnicity, Customized
Missing
3 Participants0 Participants3 Participants
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race/Ethnicity, Customized
Other
0 Participants0 Participants0 Participants
Race/Ethnicity, Customized
White
76 Participants34 Participants110 Participants
Sex: Female, Male
Female
29 Participants9 Participants38 Participants
Sex: Female, Male
Male
55 Participants27 Participants82 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
1 / 840 / 361 / 11710 / 114
other
Total, other adverse events
82 / 8435 / 36105 / 11790 / 114
serious
Total, serious adverse events
7 / 843 / 3615 / 11713 / 114

Outcome results

Primary

Complete Remission Rate

Complete remission rate is defined as the percentage of participants achieving complete remission (CR) or complete remission with incomplete marrow recovery (CRi) as their best response based on 2008 Modified International Workshop for Chronic Lymphocytic Leukemia National Cancer Institute-Working Group (IWCLL NCI-WG) criteria. CR required all of the following: * Peripheral blood lymphocytes \<4000/μL * Absence of lymphadenopathy by physical examination and computed tomography scan * No hepatomegaly or splenomegaly * Absence of disease or constitutional symptoms (unexplained fevers \>38°C, drenching night sweats, ≥10% weight loss in last 6 months) * Blood counts above the following: * Neutrophils \>1500/μL * Platelets \>100,000/μL * Hemoglobin \>11.0 g/dL * Bone marrow at least normocellular for age, \<30% lymphocytes CRi was defined as participants with CR who had persistent cytopenia unrelated to CLL but related to drug toxicity.

Time frame: From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 days

Population: All treated participants who received at least 1 dose of any study drug

ArmMeasureValue (NUMBER)
ObinutuzumabComplete Remission Rate51.2 percentage of participants
Obinutuzumab/BendamustineComplete Remission Rate16.7 percentage of participants
Primary

Percentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period)

Low tumor burden is defined as absolute lymphocyte count (ALC) \< 25 × 10\^9 /L and all lymph nodes \< 5 cm per computed tomography (CT) scans.

Time frame: From Baseline to the end of Cycles 2, 4, and 6, up to approximately 24 weeks after initial dose of study drug

Population: Participants who completed debulking and were subsequently treated with venetoclax with available data

ArmMeasureGroupValue (NUMBER)
ObinutuzumabPercentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period)From Baseline to the End of Cycle 281.4 percentage of participants
ObinutuzumabPercentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period)From Baseline to the End of Cycle 488.3 percentage of participants
ObinutuzumabPercentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period)From Baseline to the End of Cycle 695.0 percentage of participants
Obinutuzumab/BendamustinePercentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period)From Baseline to the End of Cycle 283.9 percentage of participants
Obinutuzumab/BendamustinePercentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period)From Baseline to the End of Cycle 487.1 percentage of participants
Obinutuzumab/BendamustinePercentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period)From Baseline to the End of Cycle 690.3 percentage of participants
Secondary

Duration of Response (DoR)

DoR is defined as the number of days from the date of first response (CR, CRi, nPR, or PR per the 2008 Modified IWCLL NCI-WG criteria) to the date of disease progression or death, whichever occurs first. All disease progression was to be included regardless whether the event occurred during or after the participant was taking any study drug (either venetoclax, obinutuzumab, or bendamustine). Duration of response was analyzed by Kaplan-Meier (K-M) methodology.

Time frame: From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 days

Population: All treated participants who received at least 1 dose of any study drug and who had a record of first response (CR, CRi, PR, or nPR)

ArmMeasureValue (MEDIAN)
ObinutuzumabDuration of Response (DoR)21.7 months
Obinutuzumab/BendamustineDuration of Response (DoR)NA months
Secondary

Overall Response Rate (ORR)

ORR is defined as the percentage of participants who achieved a best response of complete remission (CR), complete remission with incomplete marrow recovery (CRi), nodular partial remission (nPR), or partial remission (PR) based on the 2008 Modified IWCLL NCI-WG criteria at any time during the study as assessed by investigator up through the completion of the 65-week disease response assessment after the start of venetoclax. Participants who did not respond were considered non-responders.

Time frame: From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 days

Population: All treated participants who received at least 1 dose of any study drug

ArmMeasureValue (NUMBER)
ObinutuzumabOverall Response Rate (ORR)94.0 percentage of participants
Obinutuzumab/BendamustineOverall Response Rate (ORR)88.9 percentage of participants
Secondary

Overall Survival (OS)

OS is defined as number of days from the date of first dose of any study drug (either venetoclax, obinutuzumab, or bendamustine) to the date of death. If a participant had not died, their data was censored at the date when they were last known to be alive prior to the cutoff date.The distribution of OS was estimated using Kaplan-Meier methodology.

Time frame: From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 days

Population: All treated participants who received at least 1 dose of any study drug

ArmMeasureValue (MEDIAN)
ObinutuzumabOverall Survival (OS)NA months
Obinutuzumab/BendamustineOverall Survival (OS)NA months
Secondary

Progression-Free Survival (PFS)

PFS is defined as the number of days from the date of first dose of any study drug (either venetoclax, obinutuzumab, or bendamustine) to the date of disease progression or death, whichever occurs first. All disease progression was to be included regardless whether the event occurred during or after the participant was taking any study drug. Progression-free survival was analyzed by Kaplan-Meier methodology.

Time frame: From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 days

Population: All treated participants who received at least 1 dose of any study drug

ArmMeasureValue (MEDIAN)
ObinutuzumabProgression-Free Survival (PFS)23.3 months
Obinutuzumab/BendamustineProgression-Free Survival (PFS)NA months
Secondary

Time to Progression (TTP)

TTP is defined as the number of days from the date of first dose of any study drug (either venetoclax, obinutuzumab, or bendamustine) to date of disease progression. All disease progression was to be included regardless of whether the event occurred during or after the participant was taking any study drug.The distribution of the time to progression was estimated using Kaplan-Meier methodology.

Time frame: From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021); overall median time on follow-up was up to 787 days

Population: All treated participants who received at least 1 dose of any study drug

ArmMeasureValue (MEDIAN)
ObinutuzumabTime to Progression (TTP)NA months
Obinutuzumab/BendamustineTime to Progression (TTP)NA months
Secondary

Undetectable Minimal Residual Disease (UMRD) Rate

The level of MRD was assessed in the peripheral blood of all participants at 5 months after last dose of obinutuzumab, and at 3 months after last dose of venetoclax/end of treatment (including early study termination) to determine the rate of UMRD. Undetectable Minimal Residual Disease is defined as less than one CLL cell per 10,000 leukocytes (\< 10\^-4 ).

Time frame: From first dose of study drug until the last participant completed Week 65 assessments (data cut-off date of 13 October 2021)

Population: All treated participants who received at least 1 dose of any study drug

ArmMeasureGroupValue (NUMBER)
ObinutuzumabUndetectable Minimal Residual Disease (UMRD) RateAt Week 38100 percentage of participants
ObinutuzumabUndetectable Minimal Residual Disease (UMRD) RateAt Week 6595.5 percentage of participants
Obinutuzumab/BendamustineUndetectable Minimal Residual Disease (UMRD) RateAt Week 38100 percentage of participants
Obinutuzumab/BendamustineUndetectable Minimal Residual Disease (UMRD) RateAt Week 65100 percentage of participants

Source: ClinicalTrials.gov · Data processed: Feb 20, 2026