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CLL With Akiva Diamond, MD

Oncology / Hematology

Dr. Diamond is a lymphoma specialist, a malignant hematologist, and an assistant professor of medicine at Baylor College of Medicine and the Dan L. Duncan Comprehensive Cancer Center in Houston, Texas.

Insights on BTK Inhibitors From the 2023 ASH Annual Meeting Abstracts

Hello everyone,

This month, I want to bring your attention to an excellent review article on the cardiovascular toxicities associated with various BTK inhibitors (BTKi). In addition, the 2023 ASH Annual Meeting abstracts have been released since our last email, and I’ve chosen a few related to BTKi.

The long-term follow-up of the ALPINE study continues to demonstrate the progression-free survival (PFS) benefit of zanubrutinib over ibrutinib. Zanubrutinib is my preferred first-line BTKi. In the BRUIN study, there are approximately 30 months of follow-up data in the subgroup of previously BTKi-treated CLL patients, which consistently shows a durable PFS of 48% at 2 years.

There has been a lot of excitement and discussion on X (formerly Twitter) regarding the NCRI FLAIR study comparing FCR to ibrutinib plus venetoclax (ibr+ven) treatment. The ibr+ven arm of the study has shown an impressive 94.9% 4-year PFS. We eagerly await the results based on IGVH status and other subgroups, which will be presented at the 2023 ASH Annual Meeting.

Happy reading,
Akiva

Articles
  • Mashup Score: 33
    Paper: Pirtobrutinib in Post-cBTKi CLL/SLL: ~30 Months Follow-up and Subgroup Analysis With/Without Prior BCL2i from the Phase 1/2 BRUIN Study - 11 month(s) ago

    Program: Oral and Poster Abstracts Type: Oral Session: 642. Chronic Lymphocytic Leukemia: Clinical and Epidemiological: New Inhibitors and Cellular Therapies for Treatment of Relapsed CLL Hematology Disease Topics & Pathways: Research, clinical trials, Lymphoid Leukemias, CLL, Clinical Research, Diseases, Lymphoid Malignancies 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH 2 Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 3 Università Vita-Salute San Raffaele and

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      tobyeyre82

      Woyach et al BRUIN trial 282 cBTKi-exp #CLL pt Focus BCL2i naive vs exposed Median 4 lines ORR to #pirtobrutinib 83% BCL2i-N vs 79.7% BCL2i-E mPFS BCL2i-N 23m vs BCL2i-E 15.9m ORR⬆️regardless of prior BCL2i ⬆️PFS in BCL2i-N vs BCL2i-E Tox profile✅#ASH23 https://t.co/xjLBjXcD3S https://t.co/xWoSNG2tzy

  • Mashup Score: 151
    Paper: Ibrutinib Plus Venetoclax with MRD-Directed Duration of Treatment Is Superior to FCR and Is a New Standard of Care for Previously Untreated CLL: Report of the Phase III UK NCRI FLAIR Study - 11 month(s) ago

    Program: Oral and Poster Abstracts Type: Oral Session: 642. Chronic Lymphocytic Leukemia: Clinical and Epidemiological: Frontline Treatment With Targeted Agents in Patients With Chronic Lymphocytic Leukemia Hematology Disease Topics & Pathways: Lymphoid Leukemias, CLL, Combination therapy, Diseases, Therapies, Adverse Events, Lymphoid Malignancies, Minimal Residual Disease Peter Hillmen, MB ChB, PhD 1, David Allan Cairns, PhD 2 *, Adrian John Clifton Bloor, PhD, FRCPath, FRCP 3 *, David Allsup, MD 4 *,

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      tobyeyre82

      #ASH23 abstracts out! Here is a highlight: Check out this from the FLAIR @NCRI_partners trial MRD-directed Rx length of Ibr+Ven vs FCR phase III RCT Massive PFS adv + OS benefit for Ibr-Ven #CLL #lymsm Congrats to all UK investigators, Tal M and Pete H. https://t.co/PfXlhbcwZR https://t.co/fGmL9qonoy

  • Mashup Score: 0
    Results of a phase 3 study of IVO vs IO for previously untreated older patients (pts) with chronic lymphocytic leukemia (CLL) and impact of COVID-19 (Alliance). - 11 month(s) ago

    7500 Background: The Bruton’s tyrosine kinase inhibitor (BTKi) ibrutinib +/- anti-CD20 antibody obinutuzumab (IO) is a standard frontline regimen for older adults with CLL. BTKi alone do not often lead to complete response (CR) or undetectable minimal residual disease (uMRD), thus are given indefinitely. Smaller trials showed that IO plus venetoclax (IVO) can induce uMRD CRs which may allow successful discontinuation. Methods: Alliance for Clinical Trials in Oncology A041702 is a multicenter trial designed to evaluate if IVO with response-guided discontinuation of I improves progression free survival (PFS) versus IO with indefinite I in treatment-naïve, older CLL pts. IO is given in standard fashion, and in the IVO arm V is added at C3D1 and continued until C14D28. After 14 cycles, pts undergo response evaluation including CT scans and bone marrow biopsy with central MRD assessment by flow cytometry. Pts in IVO arm with uMRD CR discontinue I; all others continue I until progression or

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      mtmdphd

      Results of a phase 3 study of IVO vs IO for previously untreated older Pts w/ chronic lymphocytic leukemia (CLL) & impact of #COVID19 (@ALLIANCE_org A041702) - Woyach et al. #ASCO23 Abstract 7500 https://t.co/g5ExNiqWC6 #NCT03737981 #CLLsm #leusm #geriheme #COVID19nCancer