Chronic Lymphocytic Leukemia (CLL), Small Lymphocytic Lymphoma (SLL)
Conditions
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
Administered via intravenous infusion
Administered via intravenous infusion
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
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| 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 drug | 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. |
| Complete Remission Rate | 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 | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 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 days | 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 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 days | 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. |
| 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 days | 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. |
| Undetectable Minimal Residual Disease (UMRD) Rate | From 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 days | 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. |
| 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 days | 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. |
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
| Arm | Count |
|---|---|
| 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 |
| Total | 120 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | COVID-19 infection | 1 | 0 |
| Overall Study | Death | 9 | 3 |
| Overall Study | Lost to Follow-up | 0 | 2 |
| Overall Study | Non-compliance with study procedures | 1 | 1 |
| Overall Study | Other, not specified | 72 | 28 |
| Overall Study | Withdrawal by Subject | 1 | 2 |
Baseline characteristics
| Characteristic | Obinutuzumab | Obinutuzumab/Bendamustine | Total |
|---|---|---|---|
| Age, Continuous | 64.5 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 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Black or African American | 5 Participants | 2 Participants | 7 Participants |
| Race/Ethnicity, Customized Missing | 3 Participants | 0 Participants | 3 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Other | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 76 Participants | 34 Participants | 110 Participants |
| Sex: Female, Male Female | 29 Participants | 9 Participants | 38 Participants |
| Sex: Female, Male Male | 55 Participants | 27 Participants | 82 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 1 / 84 | 0 / 36 | 1 / 117 | 10 / 114 |
| other Total, other adverse events | 82 / 84 | 35 / 36 | 105 / 117 | 90 / 114 |
| serious Total, serious adverse events | 7 / 84 | 3 / 36 | 15 / 117 | 13 / 114 |
Outcome results
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
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Obinutuzumab | Complete Remission Rate | 51.2 percentage of participants |
| Obinutuzumab/Bendamustine | Complete Remission Rate | 16.7 percentage of participants |
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
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Obinutuzumab | Percentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period) | From Baseline to the End of Cycle 2 | 81.4 percentage of participants |
| Obinutuzumab | Percentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period) | From Baseline to the End of Cycle 4 | 88.3 percentage of participants |
| Obinutuzumab | Percentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period) | From Baseline to the End of Cycle 6 | 95.0 percentage of participants |
| Obinutuzumab/Bendamustine | Percentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period) | From Baseline to the End of Cycle 2 | 83.9 percentage of participants |
| Obinutuzumab/Bendamustine | Percentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period) | From Baseline to the End of Cycle 4 | 87.1 percentage of participants |
| Obinutuzumab/Bendamustine | Percentage of Participants Achieving Low Tumor Burden Status With Induction of Obinutuzumab or Obinutuzumab Plus Bendamustine (Debulking Period) | From Baseline to the End of Cycle 6 | 90.3 percentage of participants |
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)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Obinutuzumab | Duration of Response (DoR) | 21.7 months |
| Obinutuzumab/Bendamustine | Duration of Response (DoR) | NA months |
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
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Obinutuzumab | Overall Response Rate (ORR) | 94.0 percentage of participants |
| Obinutuzumab/Bendamustine | Overall Response Rate (ORR) | 88.9 percentage of participants |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Obinutuzumab | Overall Survival (OS) | NA months |
| Obinutuzumab/Bendamustine | Overall Survival (OS) | NA months |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Obinutuzumab | Progression-Free Survival (PFS) | 23.3 months |
| Obinutuzumab/Bendamustine | Progression-Free Survival (PFS) | NA months |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Obinutuzumab | Time to Progression (TTP) | NA months |
| Obinutuzumab/Bendamustine | Time to Progression (TTP) | NA months |
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
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Obinutuzumab | Undetectable Minimal Residual Disease (UMRD) Rate | At Week 38 | 100 percentage of participants |
| Obinutuzumab | Undetectable Minimal Residual Disease (UMRD) Rate | At Week 65 | 95.5 percentage of participants |
| Obinutuzumab/Bendamustine | Undetectable Minimal Residual Disease (UMRD) Rate | At Week 38 | 100 percentage of participants |
| Obinutuzumab/Bendamustine | Undetectable Minimal Residual Disease (UMRD) Rate | At Week 65 | 100 percentage of participants |